| Objective: To explore the sedative effect of dexmetomidine combined with propofol in non-intubated video-assisted thoracoscopic surgery(video-assisted thoracic surgery,VATS)and its effect on stress level and immune function,so as to provide reference for clinical anesthetic use of non-intubated VATS.Methods: From October 2017 to July 2018,40 patients underwent thoracoscopic bullae resection in our hospital.all patients participated voluntarily and signed informed consent.the preoperative ASA was grade ?-?,and there were no basic diseases of respiratory system,circulatory system and blood system.There was no contraindication of routine anesthesia,the age was 18 ~ 45 years old.They were randomly divided into two groups: dexmetomidine combined with propofol group(experimental group)and dexmetomidine group(control group),with 20 patients in each group.All patients were infiltrated by incision after disinfection sheet,and 0.5%ropivacaine was sprayed on visceral pleura,parietal pleura and lung surface after thoracotomy.Under thoracoscopy,1% lidocaine was used as corresponding intercostal and superior and inferior intercostal nerve block.1% lidocaine 2-3ml was injected locally into the submucous membrane adjacent to the vagus nerve trunk.Sufentanil citrate injection 0.2ug ? kg and midazolam injection 0.02mg/kg were injected intravenously before operation in each group.In the control group,the loading dose of dexmetomidine was 1 mg ? kg,and 10 minutes later,the patients were pumped intravenously at the speed of 0.5-1ug/kg/h until the chest was closed.The experimental group was given dexmetomidine combined with propofol,which was continuously target-controlled infusion at the concentration of 2ug/ml.After the patient fell asleep,it was adjusted to 0.4 ug / ml,and dexmetomidine was injected intravenously at the rate of 0.2-0.4ug/kg/h,both of which were discontinued before closing the chest.The heart rate was maintained in the range of 50 to 100 times perminute,the blood pressure was controlled at about 20% of the preoperative blood pressure,and when the blood oxygen saturation decreased,the oxygen flow rate was increased or short-term hand-controlled auxiliary ventilation was used.Always ensure that the blood oxygen saturation is 90% or more,the BIS is maintained in the range of65 ? 85,the dosage is adjusted according to the changes of hemodynamic indexes and BIS values during the operation,the independent respiration is retained,and respiratory inhibition is avoided.To keep the patient asleep during the operation,Intermittent blood gas measurement to ensure that PaCO2 is controlled below65 mmhg to prevent carbon dioxide accumulation.The sedative effects of the two groups were observed before anesthesia(T1),20 minutes after operation(T2)and at the end of operation(T3).The sedative effect was evaluated by Ramsay sedation score.Venous blood samples were collected before anesthesia(T1),at the end of operation(T3)and 24 hours after operation(T4).The levels of stress indexes,such as blood glucose and cortisol,were measured by enzyme-linked immunosorbent assay(ELISA).At the same time,venous blood 3-5ml was taken to analyze the level of immune indexes: the frequency of CD4+ and CD8+ by flow cytometry,and the ratio of CD4+/CD8+ was calculated.Result:(1)comparison of sedation effect between the two groups: the sedation score of the two groups was similar at T1 time(P > 0.05),and the sedation effect of the experimental group was significantly better than that of the control group at T2 and T3 time points(P < 0.05).(2)comparison of stress level between the two groups:there was no significant difference between the two groups at T1 time,but the blood glucose and cortisol at T3 and T4 were significantly higher than those at T1 time(P <0.05).And the increase in the experimental group was lower than that in the control group.The difference was significant(P < 0.05).(3)comparison of immune indexes of CD4+,CD8+ and CD4+/CD8+: there was no significant difference between the two groups at T1 time.compared with T1 time,CD4+ and CD4+/CD8+ decreased at T3 and T4 in the two groups,and the reduction rate in the experimental group was lower than that in the control group.There was no significant difference in the changes of CD8+ between the experimental group and the control group at T3 and T4(P > 0.05),but there was no significant difference between the experimental group and the control group at T3 and T4(P > 0.05).Conclusions: In non-intubated VATS,the sedative effect of dexmetomidine combined with propofol is more significant than that of dexmetomidine alone,which reduces the stress level,ensures the stability of circulation,protects the immune function of the body,and accelerates the recovery of the patients.At the same time,it provides a theoretical basis for the rational selection of anesthetic drugs for non-intubation VATS,and suggests that it should be popularized and applied in clinic. |
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