全身麻醉期间持续静脉输注右美托咪定联合羟考酮对乳腺癌患者炎症反应及免疫功能的影响

Effects of Continuous Intravenous Infusion of Dexmedetomidine Combined with Oxycodone on Inflammatory Response and Immune Function in Patients with Breast Cancer During General Anesthesia

目的:探讨长期静脉输注右美托咪定联合羟考酮对乳腺癌患者术后炎症反应和免疫功能的影响。方法:选取该院于2020年1月至2021年1月收治的乳腺癌患者共87例,根据随机数字表法分为观察组(43例)和对照组(44例)。对照组患者全身麻醉过程中给予羟考酮持续输注,观察组患者在对照组的基础上给予右美托咪定持续输注。记录两组患者术前的一般状况(包括年龄、病程、体重和血清白蛋白水平),治疗前后的免疫功能[单核细胞人白血病抗原-DR(mHLA-DR)、可溶性上皮型钙黏蛋白(sE-cad)]、炎症反应[肿瘤坏死因子(TNF-α)、白细胞介素(IL)6]和视觉模拟评分(VAS),观察不良反应。结果:术毕、术后1 d和术后3 d,两组患者mHLA-DR水平均较治疗前显著升高,sE-cad水平显著降低;且观察组患者mHLA-DR水平显著高于同期对照组,sE-cad水平显著低于同期对照组,差异均有统计学意义(P<0.05)。术毕、术后1 d和术后3 d,观察组患者TNF-α含量显著低于同期对照组,差异均有统计学意义(P<0.05)。两组患者术后6、12 h的VAS评分与术后1 h相比显著降低;观察组患者术后1、6和12 h的VAS评分显著低于对照组,差异均有统计学意义(P<0.05)。两组患者未见严重不可逆的不良反应,不良反应发生率的差异无统计学意义(P>0.05)。结论:持续静脉输注右美托咪定联合羟考酮能有效减轻乳腺癌患者术后炎症反应,改善患者术后免疫功能,减轻术后疼痛程度。

OBJECTIVE: To explore the effects of long-term intravenous infusion of dexmedetomidine combined with oxycodone on postoperative inflammatory response and immune function in patients with breast cancer. METHODS: A total of 87 patients with breast cancer admitted to the hospital from Jan. 2020 to Jan. 2021 were selected and randomly divided into observation group(43 cases) and control group(44 cases). Patients in the control group were given continuous infusion of oxycodone during general anesthesia, and patients in the observation group were given continuous infusion of dexmedetomidine on the basis of patients in the control group.The general conditions of patients in 2 groups before operation(including age, course of disease, weight, the level of serum albumin), immune function(including mHLA-DR, sE-cad), inflammatory response(including TNF-α, IL-6) and visual analogue scale(VAS) before and after treatment, and adverse reactions were recorded. RESULTS: Compared with before operation, the levels of mHLA-DR in two groups were increased significantly, while the levels of sE-cad were decreased significantly at the end of operation, 1 day and 3 days after operation;the level of mHLA-DR in observation group was significantly higher than control group, while the level of sE-cad was significantly lower than control group at the same period, with statistical significance(P<0.05). At the end of operation, 1 day and 3 days after operation, the content of TNF-α in observation group was significantly lower than control group, with statistical significance(P<0.05). VAS scores of 2 groups 6 and 12 h after operation were significantly decreased compared with 1 h after operation;VAS scores of observation groups were significantly lower than that of control group, with statistical significance(P<0.05). There was no serious irreversible adverse reaction in two groups, and there was no significant difference in the incidence of adverse drug reactions(P>0.05). CONCLUSIONS: Continuous intravenous infusion of dexmedetomidine combined with oxycodone can effectively reduce postoperative inflammatory response, improve postoperative immune function and reduce postoperative pain in patients with breast cancer.