Effect of low-dose norepinephrine combined with GDHT on perioperative inflammatory response and immune status in patients undergoing lobectomy

Objective To analyze the effect of low-dose norepinephrine combined with goal-directed hemodynamic therapy (GDHT) on perioperative inflammatory response and immune status in patients undergoing lobectomy.

Methods Eighty patients who underwent lobectomy were retrospectively selected as research subjects, and were divided into the control group (n=39) and combination group (n=41) based on different fluid management programs. The control group was managed with GDHT, and the combination group was managed with low-dose norepinerine in combination with GDHT. The following indicators in the two groups were recorded: anesthesia, surgery and mechanical ventilation time; intraoperative fluid infusion volume, blood loss and urine volume; postoperative pleural volume, time of drainage tube removal, hospital stay; preoperative (T₀), immediately after intubation (T₁), immediately at the beginning of surgery (T), immediately at the end of surgery (T₃), postoperative 1 d (T₄) heart rate (HR), mean arterial pressure (MAP), use of vasoactive drugs, blood lactate concentration. The levels of peripheral blood inflammatory factors C-reactive protein (CRP), interleukin (IL)-6, IL-8, tumor necrosis factor α (TNF-α) and immune function (CD4⁺、CD8⁺、CD4⁺/CD8⁺) were compared between the two groups at T₀-T₄. The adverse reactions between the two groups were recorded.

Results There were no statistically significant differences between the combination group and the control group in terms of anesthesia duration, surgical time, or mechanical ventilation time (P>0.05). The intraoperative fluid volume in the combination group was significantly lower than that in the control group (P < 0.01), while no significant differences were observed in intraoperative blood loss or urine output between the two groups (P>0.05). The MAP at T₁, T₂ and T₃ were higher in the combination group compared to the control group (P < 0.05 to P < 0.01), whereas there was no significant difference in HR and MAP at T₀-T₄ between the two groups (P>0.05). There was no statistically significant difference in the dosage of vasoactive drugs and blood lactate concentration between the two groups at T₀-T₄ (P>0.05). The levels of CRP, IL-6, IL-8, TNF-α and CD8⁺ in the peripheral blood of the combination group were lower those of the control group at T₄ (P < 0.01). The levels of CD4⁺ and CD4⁺/CD8⁺ in the peripheral blood of the group were higher than those of the control group at T₄ (P < 0.01). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05).

Conclusions Low-dose norepinephrine combined with GDHT reduces perioperative fluid volume, mitigates inflammatory responses, improves immune function, and may enhance postoperative recovery in lobectomy patients.