右美托咪定联合局部浸润麻醉对乳腺纤维瘤切除术患者免疫功能及应激反应的影响

Effects of Dexmedetomidine Combined with Local Infiltration Anesthesia on Immune Function and Stress Reaction in Treatment of Patients Undergoing Breast Fibromectomy

目的探讨右美托咪定联合局部浸润麻醉对乳腺纤维瘤切除术患者免疫功能及应激反应的影响。方法选取2018年1月—2019年12月行乳腺纤维瘤切除术120例,根据麻醉方法不同分为观察组和对照组,每组60例。对照组采用局部浸润麻醉,观察组采用右美托咪定联合局部浸润麻醉。比较两组入室后5 min(T0)、切皮时(T1)、手术开始后10 min(T2)、术毕(T3)时心率和平均动脉压(MAP),比较T0、T3、术后6 h(T4)、术后12 h(T5)时血清去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)、CD4+、CD8+、NK细胞水平,比较术后1 h、T4、T5时疼痛视觉模拟评分法(VAS)评分,同时统计不良反应情况。结果观察组T1、T2、T3时心率、MAP水平低于对照组(P<0.05,P<0.01)。观察组T3、T4、T5时血清NE、E、Cor水平低于对照组,CD4+、CD8+、NK细胞水平高于对照组(P<0.05,P<0.01)。术后1 h、T4、T5时,观察组VAS评分低于对照组(P<0.01)。两组不良反应总发生率比较差异无统计学意义(P>0.05)。结论在乳腺纤维瘤切除术中,采用右美托咪定联合局部浸润麻醉,能有效改善术后应激反应、免疫功能及疼痛程度,安全性高。

Objective To investigate the effects of Dexmedetomidine combined with local infiltration anesthesia on immune function and stress reaction in treatment of patients undergoing breast fibromectomy.Methods A total of 120 patients undergoing breast fibromectomy between January 2018 and December 2019 were selected and divided into observation group(n=60)and control group(n=60)according to different anesthesia methods.Control group was treated with local infiltration anesthesia,while observation group was treated with Dexmedetomidine combined with local infiltration anesthesia.In two groups,levels of heart rate(HR)and mean arterial pressure(MAP)at the 5 th min after entry(T0),at the time of skin incision(T1),at 10 th min after operation(T2)and at the end of operation(T3)were compared;levels of serum norepinephrine(NE),epinephrine(E),cortisol(Cor),CD4+,CD8+and NK cells at T0,T3,at 6 th h after operation(T4)and at 12 th h after operation(T5)were compared;visual analogue scale(VAS)scores of pain at 1 st h after operation,T4 and T5 were compared,and incidence rates of adverse reactions were also recorded.Results Compared with those in control groups,levels of HR and MAP at T1,T2 and T3 were significantly lower(P<0.05,P<0.01);levels of serum NE,E and Cor at T3,T4 and T5 were significantly lower,while levels of CD4+,CD8+and NK cells were significantly higher in observation group(P<0.05,P<0.01).VAS scores at 1 st h after operation,T4 and T5 in observation group were significantly lower than those in control group(P<0.01).There was no significant difference in the total incidence rate of adverse reactions between two groups(P>0.05).Conclusion Dexmedetomidine combined with local infiltration anesthesia in application of patients undergoing breast fibromectomy may effectively improve postoperative stress reaction,immune function and pain degree with good safety.