右美托咪定对中老年七氟烷全身麻醉乳腺癌根治术患者细胞免疫功能的影响分析

Effects of Dexmedetomidine on cellular immune function in middle-aged and elderly patients undergoing radical mastectomy for breast cancer and Sevoflurane general anesthesia

目的分析右美托咪定(Dexmedetomidine,DEX)对七氟烷全身麻醉乳腺癌根治术中老年患者细胞免疫功能的影响。方法本研究为随机、双盲、对照临床研究,选取2017年1月至2018年3月于本院拟行七氟烷全身麻醉乳腺癌根治术的72例中老年女性患者为研究对象,采用随机数表法将其分为观察组和对照组,每组各36例。所有患者术中均采用相同的麻醉诱导与维持方案,观察组患者在麻醉诱导前30分钟静脉泵入DEX 0.5μg/kg,于15分钟内泵注完毕,之后以0.4μg/(kg·h)剂量维持,直至手术结束前10分钟;对照组患者给予等量生理盐水。比较两组患者的麻醉诱导前(T0)、手术结束即刻(T1)、术后6小时(T2)、术后24小时(T3)、术后72小时(T4)时的外周血CD4+/CD8+比值、辅助性细胞(T help cells,Th)1/Th2比值、调节性T细胞(regulatory T cells,Treg)及自然杀伤细胞(natural killer cell,NK细胞)比例。结果与T0时比较,对照组T2、T3时的血CD4+/CD8+比值、Th1/Th2比值、NK细胞比例均显著降低(P_均<0.05),Treg细胞比例显著升高(P<0.05),而观察组仅T2、T3时的NK细胞比例均显著降低(P_均<0.05);观察组T2、T3时的血CD4+/CD8+比值、Th1/Th2比值、NK细胞比例均显著高于同期对照组(P_均<0.05),Treg细胞比例均显著低于同期对照组(P_均<0.05)。结论DEX能有效改善中老年患者七氟烷全身麻醉乳腺癌根治术后的细胞免疫功能,且安全性高,值得临床推广应用。

ObjectiveTo analyze the effects of Dexmedetomidine （DEX） on cellular immune function in middle-aged and elderly patients undergoing radical mastectomy for breast cancer and Sevoffurane general anesthesia. MethodThis study was a randomized, double-blind and controlled clinical trial. 72 middle-aged and elderly women underwent radical mastectomy for breast cancer and Sevoffurane compound general anesthesia in our hospital from January 2017 to March 2018 were enrolled and they were divided into observation group and control group by random number table method, 36 cases in each group. All patients accepted the same anesthesia induction and maintenance method. Patients in observation group were pumped into DEX 0.5 μg/kg in 15 minutes before induction of anesthesia, followed by 0.4 μg/（kgffh） until 10 minutes before the end of operation; patients in control group were given the same amount of physiological saline. The levels of peripheral blood CD4＋/CD8＋ T lymphocyte ratio, T help cells （Th） 1/Th2 ratio, regulatory T cells （Treg） and natural killer cell （NK cell） were measured before induction of anesthesia （T0）, at the end of the operation （T1）, 6h after operation （T2）, 24h after operation （T3） and 72h after operation （T4）. ResultCompared with T0, CD4＋/CD8＋ ratio, Th1/Th2 ratio and the proportion of NK cell at T2 and T3 decreased signiffcantly （Pall〈0.05）, and the proportion of Treg signiffcantly increased in control group （P 〈0.05）; while only the proportion of NK cell at T2 and T3 in observation group decreased signiffcantly （P〈 0.05）. For inter-group comparison, CD4＋/CD8＋ ratio, Th1/Th2 ratio and the proportion of NK cell at T2 and T3 in observation group were signiffcantly higher than those in control group （Pall〈 0.05）, and the proportion of Treg were signiffcantly lower than that in control group （Pall〈 0.05）. ConclusionDEX can signiffcantly improve postoperative cellular immune function after radical mastectomy for middle-aged and elderly patients hocussed by Sevoffurane general anesthesia. It is safe and worthy of clinical application.