围手术期口服右美托咪定对改良乳腺癌根治术患者术后早期免疫功能的影响

Effect of perioperative oral dexmedetomidine on early postoperative immune function in breast cancer patients undergoing modified radical mastectomy

目的探讨围手术期口服右美托咪定对改良乳腺癌根治术患者术后早期免疫功能的影响。方法选取2019年5—12月青岛大学附属泰安市中心医院乳腺外科行改良乳腺癌根治术患者,随机分为观察组和对照组。观察组术前3 d至术后3 d,将右美托咪定2.5μg/kg加入10%葡萄糖溶液稀释至10 m L,每晚1次口服;对照组给予10%葡萄糖溶液10 m L口服。分别于入院时(T_(0))、麻醉诱导前(T_(1))、术后第1天(T_(2))、术后第3天(T_(3))、术后第7天(T_(4))取外周静脉血5 m L,采用细胞流式术动态检测T淋巴细胞亚群中CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)比值。比较两组术后6、24、48 h的疼痛视觉模拟评分(VAS)及Ramsay镇静评分。结果共纳入40例患者,观察组和对照组各20例。观察组术后6 h和24 h VAS低于对照组,术后6、24、48 h的Ramsay镇静评分高于对照组(P<0.05)。对照组在T_(2)和T_(3)时的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)比值较T_(0)和T_(1)均有降低,CD8^(+)较T_(0)和T_(1)升高(P<0.05);观察组在T_(2)时CD3^(+)较T_(0)和T_(1)降低(P<0.01),在T_(4)时CD3^(+)、CD4^(+)/CD8^(+)比值较T_(0)和T_(1)均升高,CD8^(+)较T_(0)和T_(1)降低(P<0.05);观察组T_(2)、T_(3)、T_(4)时的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)比值较对照组同时点升高(P<0.05),CD8^(+)较对照组同时点降低,差异均有统计学意义(P<0.05)。结论围手术期口服右美托咪定可增强改良乳腺癌根治术患者术后镇痛和镇静水平,改善机体细胞免疫功能,促进早期康复。

Objective To observe the effect of perioperative oral dexmedetomidine on early postoperative immune function in breast cancer patients undergoing modified radical mastectomy.Methods Patients with breast cancer undergoing modified radical mastectomy in the Affiliated Taian City Central Hospital of Qingdao University were randomly divided into an observation group and a control group.In the observation group,dexmedetomidine was given orally at 2.5μg/kg diluted in 10%dextrose solution to 10 mL once per night from 3 days before the operation to 3 days after the operation.The control group was given 10 mL of 10%glucose solution orally.Five milliliters of peripheral venous blood were obtained at admission(T_(0)),before induction of anesthesia(T_(1)),1 day postoperatively(T_(2)),3 days postoperatively(T_(3))and 7 days postoperatively(T_(4)),and the percentage of lymphocytes such as CD3^(+),CD4^(+)and CD8^(+)T lymphocyte and the ratio of CD4^(+)/CD8^(+)in the T lymphocyte subset were dynamically examined by flow cytometry.In addition,the pain visual analog scale(VAS)and Ramsay sedation scale of the two groups of patients were compared at 6,24,and 48 h postoperatively.Results A total of 40 patients were included,with 20 patients in the observation group and 20 patients in the control group.The VAS of the observation group at 6 h and 24 h after the operation was significantly lower than that in the control group,and the Ramsay sedation score in the observation group was significantly higher than that in the control group at 6,24 and 48 h(P<0.05).In the control group,at T_(2)and T_(3),the percentages of CD3^(+),CD4^(+)T lymphocytes,and CD4^(+)/CD8^(+)ratio were lower than those at T_(0)and T_(1),while the percentage of CD8^(+)T lymphocytes was higher than that at T_(0)and T_(1)(P<0.05).In the observation group,the percentages of CD3^(+)T lymphocytes at T_(2)was significantly lower than that at T_(0)and T_(1)(P<0.01),the percentages of CD3^(+)and CD4^(+)/CD8^(+)ratio at T_(4)was higher than that at T_(0)and T_(1),and the percentages of CD8^(+)T lymphocytes was lower than that at T_(0)and T_(1)(P<0.05).Compared with the control group,the observation group can significantly increase the percentages of CD3^(+),CD4^(+)T lymphocytes and CD4^(+)/CD8^(+)ratios(P<0.05)and decrease the percentage of CD8^(+)T lymphocytes(P<0.05)at T_(2),T_(3)and T_(4).The VAS score of the observation group at 6 and 24 h after the operation was significantly lower than that of the control group,and the Ramsay score of the observation group at 6 h and 24 h after the operation was significantly higher than that of the control group(P<0.05).Conclusion Perioperative oral dexmedetomidine can enhance postoperative analgesia and sedation level in patients undergoing modified radical mastectomy,improves the cellular immune function,and promotes early recovery.