右美托咪定对乳腺癌根治术后患者苏醒及免疫功能的影响  

Effects of dexmedetomidine on postoperative consciousness and immune function in patients undergoing radical resection for breast cancer

作　　者：聂瑞霞[1] 刘冰冰[1] 周代伟[1] 陈彬[1] 梁亚统[1] 李俊[1] 

机构地区：[1]广东省第二人民医院麻醉科,广州510317

出　　处：《中国肿瘤临床与康复》2017年第11期1343-1346,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨右美托咪定对乳腺癌根治术后患者苏醒及免疫功能的影响。方法选取2014年2月至2016年6月间在广东省第二人民医院行乳腺癌根治术的86例乳腺癌患者,采用随机数表法分为观察组和对照组,每组43例。两组患者均给予舒芬太尼及顺式阿曲库铵诱导全身麻醉,观察组患者于麻醉诱导前30min静脉给予0.5μg/kg的右美托咪定,并持续至麻醉诱导插管,对照组患者给予等量的生理盐水。观察并比较两组患者术后睁眼时间和拔管时间,采用Riker镇静躁动评分及Ramsay镇静评分评价患者镇静和躁动程度,采用流式细胞术检测术前(T_0)、手术开始2 h(T_2)、术后24 h(T_(24))及术后72h(T_(72))的全血CD3^+、CD4^+、CD8^+和自然杀伤细胞(NK)水平,采用酶联免疫吸附测定(Elisa)法检测两组血清应激指标脂质过氧化物(LPO)、皮质醇(Cor)、促肾上腺皮质激素(ACT_H)及醛固酮(ALD)水平并进行比较。结果观察组患者的睁眼时间和拔管时间显著低于对照组患者,差异有统计学意义(P<0.05)。观察组患者的Riker镇静躁动评分高于对照组患者,Ramsay镇静评分均低于对照组患者,差异均有统计学意义(均P<0.05)。在T_2、T_(24)和T_(72)时,观察组患者的CD3^+、CD4^+、CD8^+和NK细胞水平显著高于对照组患者,差异均有统计学意义(均P<0.05)。T_2、T_(24)和T_(72)时,观察组患者的LPO、Cor、ACT_H和ALD水平均显著低于对照组患者,差异均有统计学意义(均P<0.05)。结论右美托咪定应用于乳腺癌根治术后患者可加速患者的苏醒,改善镇静和躁动程度,减轻免疫抑制和应激反应。Objective To investigate the effect of dexmedetomidine on postoperative consciousness and immune function in patients with radical resection for breast cancer. Methods Eighty-six patients with breast cancer underwent radical resection for breast cancer were selected at Guangdong Province Second People＇s Hospital from February 2014 to June 2016 and divided into an observation group and a control group with 43 patients in each group,according to the random number table method. Both groups were given sufentanil and cisatracurium induced general anesthesia. The observation group was intravenously administered 0. 5μg/kg dexmedetomidine at 30 min before anesthesia induction and until intubation after the anesthetic induction. The control group was given the same amount of saline. The time to eye-open and extubation were observed and compared between the two groups. Riker sedation-agitation scale（ SAS） and Ramsay sedation score were used to assess sedation and agitation. The levels of whole blood CD3^＋,CD4^＋,CD8^＋and natural killer cells（ NK） before operation（ T0）,at 2 h after surgery（ T2）,24 h after surgery（ T24）and 72 h after surgery（ T72） were detected using flow cytometry. The stress index of serum lipid peroxide（ LPO） and cortisol（ Cor）,adrenocorticotropic hormone（ ACTH） and aldosterone（ ALD） were detected by enzyme linked immunosorbent assay（ ELISA）. Results The time to eye-open and extubation was significantly lower in the observation group than in the control group（ P〈0. 05）. The Riker sedation-agitation score was higher and Ramsay sedation score was lower in the observation group than in the control group（ P〈0. 05）. At T2,T24 and T72,the levels of CD3^＋,CD4^＋,CD8^＋and NK cells were significantly higher in the observation group than in the control group（ P〈0. 05）. At T2,T24 and T72,the levels of LPO,Cor,ACTH and ALD were significantly lower in the observation group than in the control group（ P〈0. 05）.Conclusion Dexmedetomidine can

关 键 词：乳腺癌根治手术 右美托咪定 苏醒时间 免疫功能 应激反应 

分 类 号：R614[医药卫生—麻醉学] R737.9[医药卫生—外科学]