右美托咪定对乳腺癌改良根治术患者细胞免疫功能的影响  

Effects of dexmedetomidine on cellular immune function in patients undergoing modified radical mastectomy for breast cancer

作　　者：聂冰洁 朱敏 刘亚华[2] 刘艳萍[2] NIE Bingjie;ZHU Min;LIU Yahua;LIU Yanping(The Third Affiliated Clinical Medical College of Xinjiang Medical University,Urumqi,830000,China;Center of Anesthesia and Perioperative Medicine,the affiliated Tumor Hospital of Xinjiang Medical University,Urumqi,830000,China)

机构地区：[1]新疆医科大学附属第三临床医学院,乌鲁木齐830000 [2]新疆医科大学附属肿瘤医院麻醉与围术期医学中心,乌鲁木齐830000

出　　处：《新疆医学》2022年第2期135-138,共4页Xinjiang Medical Journal

基　　金：新疆维吾尔自治区自然科学基金(项目编号:2019D01C250)。

摘　　要：目的观察右美托咪定对乳腺癌改良根治术患者术后细胞免疫功能的影响。方法选取2019年12月-2020年6月于本院行乳腺癌改良根治术的原发性乳腺癌患者112例,年龄18-70岁,ASA I-III级,乳腺癌TNM分期T2-3N0-2M0期,按照数字表随机分入观察组和对照组,其中观察组57例,对照组55例。观察组麻醉诱导前15min以1ug/kg的速度持续静脉泵注右美托咪定,之后以0.5μg/(kg·h)的速度持续泵注2 h,手术时间不足2 h者输注至术毕。对照组则持续泵注同等量的生理盐水。分别于麻醉诱导前即术前以及术后24 h采集乳腺癌患者外周静脉血,流式细胞仪检测CD3^(+)、CD4^(+)、CD8^(+)细胞和自然杀伤细胞(Natural Kill cell,NK细胞)百分比及干扰素γ(Interferon-γ,IFN-γ)、白细胞介素-4(Interleukin-4,IL-4)、白细胞介素-12(Interleukin-12,IL-12)浓度。结果两组患者术后的CD3^(+)、CD4^(+)、NK细胞百分比及IL-12和IFN-γ浓度均较同组术前降低(P<0.05),CD8^(+)细胞百分比和IL-4浓度均较同组术前升高(P<0.05);观察组患者术后24 h时点的CD3^(+)、CD4^(+)、NK细胞水平及IL-12和IFN-γ的水平均较对照组患者术后24 h时点高(P<0.05),而CD8^(+)细胞水平和IL-4水平较对照组低(P<0.05)。结论围术期使用右美托咪定有助于改善乳腺癌改良根治术患者的细胞免疫功能,降低围术期应激。Objective To observe the effect of dexmedetomidine on cellular immune function in patients undergoing modified radical mastectomy for breast cancer.Methods A total of 112 patients with primary breast cancer(aged from 18 to 70 years,ASA grading I-III,TNM stage being in T2-3N0-2M0)who underwent modified radical mastectomy in our hospital from December 2019 to June 2020 were selected and divided into observation group and control group by random number table method.There were 57 cases in the observation group and 55 cases in the control group.In the observation group,dexmedetomidine was continuously injected intravenously at the rate of 1μg/kg for 15 minutes before anesthesia induction,and then at the rate of 0.5μg/(kg·h)for 2h.For patients with less than 2h operation time,dexmedetomidine was continuously injected until the end of surgery.The control group were continued to pump the same amount of saline.The percentages of CD3^(+),CD4^(+),CD8^(+)cells,NK cells,interferon-γ(IFN-γ),and concentrations of interleukin-4(IL-4)and interleukin-12(IL-12)were detected by peripheral venous blood sampling before anesthesia induction and 24h after surgery,respectively.Results The percentages of CD3^(+),CD4^(+),NK cells and the concentrations of IL-12 and IFN-γin both groups after surgery were decreased compared with those before surgery(P<0.05),while the percentages of CD8^(+)cells and the concentrations of IL-4 in both groups were increased compared with those before surgery(P<0.05).The levels of CD3^(+),CD4^(+),NK cells and the levels of IL-12 and IFN-γin observation group at 24 h after surgery were higher than those in control group(P<0.05),while the levels of CD8^(+)cells and IL-4 in observation group were lower than those in control group(P<0.05).Conclusions Perioperative use of dexmedetomidine can improve cellular immune function and reduce perioperative stress in patients undergoing modified radical mastectomy for breast cancer.

关 键 词：右美托咪定 原发性乳腺癌 改良根治术 细胞免疫功能 

分 类 号：R614[医药卫生—麻醉学]