2023 年第 9 期 第 18 卷

右美托咪定预处理对肺癌根治术患者循环肿瘤细胞和微转移的影响

Effects of dexmedetomidine pretreatment on circulating tumor cells and micrometastases in patients undergoing radical resection of lung cancer

作者：乔燕1陈湉1廖兴志1施冬冬1张灵犀2尹荣2

英文作者：Qiao Yan1 Chen Tian1 Liao Xingzhi1 Shi Dongdong1 Zhang Lingxi2 Yin Rong2

单位：1中国人民解放军联勤保障部队第九〇四医院麻醉科，无锡214000；2上海交通大学医学院附属第九人民医院麻醉科，上海201900

英文单位：1Department of Anesthesiology the 904th Hospital of Joint Logistics Support Force of the Chinese People′s Liberation Army Wuxi 214000 China; 2Department of Anesthesiology Shanghai Ninth People′s Hospital Shanghai Jiaotong University School of Medicine Shanghai 201900 China

关键词：肺癌；右美托咪定；前锯肌平面阻滞；胸腔镜手术；循环肿瘤细胞；微转移

英文关键词：Lungcancer;Dexmedetomidine;Serratusanteriorplaneblock;Thoracoscopicsurgery;Circulatingtumorcells;Micrometastases

• 摘要：

• 目的  探讨右美托咪定预处理对前锯肌平面阻滞（SAPB）联合全身麻醉的胸腔镜下肺癌根治术患者循环肿瘤细胞、微转移指标的影响。方法 选择2018年1月至2022年1月于中国人民解放军联勤保障部队第九〇四医院行胸腔镜手术治疗的80例非小细胞肺癌患者，采用随机数字表法分为观察组和对照组，各40例。2组均采用SAPB联合全身麻醉，观察组麻醉诱导前予盐酸右美托咪定注射液静脉泵注，对照组麻醉诱导前予0.9%氯化钠注射液静脉泵注。主要观察指标为麻醉诱导前（T0）、手术开始1 h（T4）、术毕（T5）、术后24 h（T6）、术后48 h（T7）、术后72 h（T8）循环肿瘤细胞、微转移、细胞免疫指标。次要观察指标为T0、预处理5 min（T1）、手术开始5 min（T2）、手术开始30 min（T3）、T4、T5心率、平均动脉压（MAP），T0~1呼吸频率及T2~5脑电双频指数（BIS）。结果 对照组T0、T4~8外周血循环肿瘤细胞、表皮生长因子受体mRNA、肺特异性X蛋白mRNA、细胞角蛋白19 mRNA水平逐渐增加，观察组各指标水平于T4~5增加后于T6~8降低，且观察组T6~8各指标水平均低于对照组［循环肿瘤细胞：（20.2±4.4）个比（24.9±6.9）个、（18.2±3.0）个比（25.6±6.8）个、（17.4±2.6）个比（26.3±7.8）个］（均P＜0.05）。对照组T0、T4~8外周血CD+3 T细胞、CD+4 T细胞、CD+4/CD+8比值逐渐降低，观察组各指标于T4~5降低后于T6~8增高，且观察组T6~8各指标均高于对照组（均P＜0.05）。观察组T2~5心率、MAP、BIS均低于对照组（均P＜0.05）。2组不良反应发生率比较差异无统计学意义（P=0.429）。结论 右美托咪定预处理可获得更好的麻醉深度，稳定血流动力学，保护SAPB联合全身麻醉的胸腔镜下肺癌根治术患者的细胞免疫功能，抑制循环肿瘤细胞和微转移。

• Objective To investigate the effects of dexmedetomidine pretreatment on circulating tumor cells and micrometastases indicators in patients undergoing thoracoscopic radical resection of lung cancer with serratus anterior plane block (SAPB) combined with general anesthesia. Methods From January 2018 to January 2022, 80 patients with non-small cell lung cancer undergoing thoracoscopic surgery in the 904th Hospital of Joint Logistics Support Force of the Chinese People′s Liberation Army were selected. They were divided into observation group and control group according to the random number table method, with 40 cases in each group. Both groups were treated with SAPB combined with general anesthesia, the observation group was given dexmedetomidine injection by intravenous pump before anesthesia induction, and the control group was given 0.9% sodium chloride injection by intravenous pump before anesthesia induction. The main observation indicators were circulating tumor cells, micrometastases and cellular immunity indicator before anesthesia induction（T0）, 1 h after operation beginning（T4）, the end of operation（T5）, 24 h（T6）, 48 h（T7） and 72 h（T8）after operation. Secondary observation indicators were heart rate and mean arterial pressure (MAP) at T0, 5 min of pretreatment（T1）, 5 min after operation beginning（T2） and 30 min after operation beginning（T3）, respiratory rate at T0-1 and bispectral index (BIS) at T2-5. Results Levels of circulating tumor cells, epidermal growth factor receptor mRNA, lung specific X protein mRNA and cytokeratin 19 mRNA in peripheral blood gradually increased in the control group at T0 and T4-8, the levels in the observation group increased at T4-5, and then decreased at T6-8, and those in the observation group were lower than those in the control group at T6-8 ［circulating tumor cells: （20.2±4.4）cells vs （24.9±6.9）cells,（18.2±3.0）cells vs （25.6±6.8）cells,（17.4±2.6）cells vs （26.3±7.8）cells］(all P<0.05). CD+3 T cell, CD+4 T cell and CD+4/CD+8 ratio in peripheral blood in the control group gradually decreased at T0 and T4-8, those in the observation group decreased at T4-5, and then increased at T6-8, and those in the observation group were higher than those in the control group at T6-8 (all P<0.05). Heart rate, MAP and BIS in the observation group at T2-5 were lower than those in the control group (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P=0.429). Conclusions  sPretreatment with dexmedetomidine can obtain better depth of anesthesia, stabilize hemodynamics, protect the cellular immune function of patients undergoing thoracoscopic radical resection of lung cancer with SAPB combined with general anesthesia, and inhibit circulating tumor cells and micrometastases.