探讨静脉泵注利多卡因复合右美托咪定对胸腔镜手术患者肺功能以及免疫功能的影响。

选择江苏省邳州市人民医院胸外科2016年7月至2018年7月50例胸腔镜手术患者，ASA Ⅰ～Ⅱ级，其中男31例，女19例，均为单侧肺部病变，且采用支气管内麻醉，分为对照组24例，研究组26例，对照组在麻醉诱导前15 min静脉泵注右美托咪定0.5 μg/kg，后改为0.25 μg/kg·h持续静脉泵注至关胸，研究组在对照组基础上静脉泵注利多卡因，即麻醉诱导前15 min泵注利多卡因1 mg/kg，后改为1 mg/kg·h持续泵注至关胸。比较两组单肺通气时(T₁)、单肺通气结束(T₂)和返回病房前(T₃)氧合指数(OI)、肺内分流率()和呼吸指数(RI)，记录两组诱导前(T₄)、术毕(T₅)和术后24 h(T₆)CD4⁺、CD8⁺和CD4⁺/CD8⁺。

T₁时，两组OI、、RI比较差异无统计学意义(P>0.05)，T₂、T₃时，研究组OI[(363.48±24.11)mmHg vs. (335.48±31.11)mmHg、(388.84±34.64)mmHg vs. (360.88±38.42)mmHg]高于对照组(P<0.05)， [(14.86±2.58)% vs. (18.33±2.53)%、(12.56±2.28)% vs. (15.57±1.90)%]、RI[(0.82±0.18) vs. (1.07±0.14)、(0.52±0.12) vs (0.78±0.13)]低于对照组(P<0.05)。T₄时，两组CD4⁺、CD8⁺和CD4⁺/CD8⁺比较差异无统计学意义(P>0.05)，T₅、T₆时，两组CD8⁺比较差异无统计学意义(P>0.05)，研究组CD4⁺[(36.16±7.84)% vs. (29.48±8.10)%、(39.72±8.79)% vs. (32.48±8.87)%]、CD4⁺/CD8⁺[(2.12±0.20) vs. (2.00±0.20)、(2.13±0.19) vs. (2.01±0.17)]高于对照组(P<0.05)。

静脉泵注利多卡因复合右美托咪定提高胸腔镜手术患者的氧合指数，降低肺内分流率和呼吸指数，提高CD4⁺、CD4⁺/CD8⁺，改善肺功能及免疫功能。

To investigate the effects of intravenous pumping of lidocaine combined with dexmedetomidine (Dex) on the lung function and immune function of the patients undergoing thoracoscopic surgery.

A total of 50 patients (ASA Ⅰ-Ⅱ grade, 31 males and 19 females) undergoing thoracoscopic surgery with unilateral pulmonary lesions and intrabronchial anesthesia in the Department of Thoracic Surgery of Pizhou People′s Hospital of Jiangsu Province from July 2016 to July 2018 were selected for this study. The patients were randomly divided into a control group (n=24) and a study group (n=26). In the control group, continuous intravenous pumping of Dex 0.5 μg/kg was given in 15 minutes before anesthesia induction, and then 0.25 μg/kg·h was continuously pumped until the thoracic incision was closed. In the study group, continuous intravenous pumping of lidocaine 1 mg/kg was given in 15 minutes before anesthesia induction, and then lidocaine 1 mg/kg·h was continuously pumped until the thoracic incision was closed. The oxygenation index (OI), intrapulmonary shunt rate () and respiratory index (RI) were compared at one-lung ventilation (T₁), at the end of one-lung ventilation (T₂) and before returning to the ward (T₃) between the two groups. CD4⁺ , CD8⁺ and CD4⁺ /CD8⁺ were recorded before anesthesia induction (T₄), after operation (T₅) and at postoperative 24 hours (T₆) in the two groups.

No significant difference was found in the OI, and RI at T₁ between the two groups (P>0.05). At T₂ and T₃, the values of OI in the study group [(363.48±24.11) mmHg and (388.84±34.64) mmHg, respectively] were significantly higher than those of the control group [(335.48±31.11) mmHg and (360.88±38.42) mmHg, respectively, P<0.05], the values of in the study group [(14.86±2.58)% and (12.56±2.28)%, respectively] were significantly lower than those of the control group [(18.33±2.53)% and (15.57±1.90)%, respectively, P<0.05], and the values of RI in the study group [(0.82±0.18) and (0.52±0.12), respectively] were significantly lower than those of the control group [(1.07±0.14) and (0.78±0.13), respectively, P<0.05]. There was no significant difference in CD4⁺ , CD8⁺ and CD4⁺ /CD8⁺ at T₄ between the two groups (P>0.05). At T₅ and T₆, there was no significant difference in CD8⁺ between the two groups (P>0.05), however, the values of CD4⁺ in the study group [(36.16±7.84)% and (39.72±8.79)%, respectively] were significantly higher than those of the control group [(29.48±8.10)% and (32.48±8.87)%, respectively, P<0.05], and the values of CD4⁺ /CD8⁺ in the study group [(2.12±0.20) and (2.13±0.19), respectively] were significantly higher than those of the control group [(2.00±0.20) and (2.01±0.17), respectively, P<0.05)].

Intravenous pumping of lidocaine combined with Dex could increase the OI, decrease the () and RI, increase the CD4⁺ and CD4⁺ /CD8⁺ , and improve the lung function and immune function of the patients undergoing thoracoscopic surgery.