伤害感受水平指数指导瑞芬太尼输注靶浓度对接受乳腺癌根治术患者细胞免疫和缺氧诱导因子-1α的影响

Nociceptive level index guides the effect of remifentanil infusion target concentration on cellular immunity and HIF-1αin patients undergoing radical mastectomy

目的探讨伤害感受水平(NOL)指数应用于乳腺癌根治术对患者的细胞免疫和缺氧诱导因子(HIF)-1α的影响。方法招募2022年12月至2023年12月行乳腺癌根治术的80例患者,随机将患者分为观察组和对照组。观察组控制NOL指数在30~50,依此调整瑞芬太尼靶浓度,对照组起始采用瑞芬太尼4 ng/mL靶控输注,依据血流动力学调整瑞芬太尼靶浓度。记录瑞芬太尼平均靶浓度;记录手术前1 d及手术后1 d患者的静脉血CD4^(+)、CD8^(+)以及NK细胞值,测定血清中HIF-1α水平。结果两组患者的麻醉时间、手术时间、术中MAP、HR、丙泊酚靶浓度和术后VAS评分均差异无统计学意义(P>0.05),观察组术中的瑞芬太尼平均靶浓度低于对照组(P<0.05);在术后1 d,观察组的CD4^(+)、CD4^(+)/CD8^(+)、NK细胞值均高于对照组,HIF-1α水平低于对照组(P<0.05)。相比术前1 d,观察组患者在术后1 d的CD4^(+)、CD4^(+)/CD8^(+)较低,HIF-1α水平较高(P<0.05);相比术前1 d,对照组患者在术后1天的CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)及NK细胞值较低,HIF-1α水平较高(P<0.05)。结论NOL指数应用于全麻下乳腺癌根治术可以减少术中瑞芬太尼的靶浓度,降低瑞芬太尼对细胞免疫的抑制,保护NK细胞的活性,同时减少HIF-1α升高水平,由此推断对患者肿瘤免疫微环境的影响更小。

Objective To investigate the impact of nociceptive level(NOL)index on cellular immunity and HIF-1αin patients with radical breast cancer.Methods A total of 80 patients undergoing radical mastectomy between December 2022 and December 2023 were randomly assigned into an experimental group and a control group using a random number table method.The NOL index in the experimental group was maintained within the range of 30 to 50,with corresponding adjustments made to achieve the target concentration of remifentanil.In contrast,the control group initially received remifentanil at a target controlled infusion rate of 4 ng/mL,which was adjusted based on hemodynamics.The average target concentration of remifentanil was recorded for both groups.Venous blood samples were collected from all participants one day before and one day after surgery to measure CD4^(+),CD8^(+)cell counts,NK cell activity,as well as serum levels of HIF-1α.Results There were no significant differences observed in anesthesia time,operation time,intraoperative mean arterial pressure(MAP),heart rate(HR),and postoperative visual analog scale(VAS)scores between the two groups.The average target concentra‐tion of remifentanil in the experimental group was significantly lower than that in the control group(P<0.05).Moreover,the experimental group exhibited higher values of CD4^(+),CD4^(+)/CD8^(+)ratio,and NK cells compared to the control group,while demonstrating a lower level of HIF-1αexpression(P<0.05).In addition,within the experimental group,there was a decrease in CD4^(+)count and CD4^(+)/CD8^(+)ratio one day after surgery compared to one day before surgery;meanwhile,HIF-1αexpression increased significantly after surgery when compared to preoperative levels(P<0.05).Similarly,within the control group,there was a decrease observed in CD4^(+),CD8^(+),CD4^(+)/CD8^(+)ratio as well as NK cell values one day after surgery when compared to preoperative levels;additionally,HIF-1αexpression showed a significant increase after surgery when compared to preoperative levels(P<0.05).Conclusion The implementation of NOL monitoring during radical mastectomy under general anes‐thesia can effectively lower the required remifentanil concentration,thereby mitigating its suppressive effects on T lymphocytes,preserving NK cell activity,and reducing elevated levels of HIF-1α.Consequently,this approach exerts minimal impact on the tumor immune microenvironment(TIME)in patients.