瑞马唑仑与丙泊酚对乳腺癌根治术患者围术期细胞免疫功能的影响比较

目的:比较瑞马唑仑与丙泊酚静脉麻醉对乳腺癌根治术患者围术期细胞免疫功能的影响。方法:将择期行乳腺癌根治术的患者80例,采用随机数字表法分为瑞马唑仑组(R组)和丙泊酚组(P组)。麻醉诱导时,R组患者静脉推注瑞马唑仑0.2 mg/kg+舒芬太尼0.3μg/kg+顺阿曲库铵0.2 mg/kg;P组患者静脉推注丙泊酚2 mg/kg+舒芬太尼0.3μg/kg+顺阿曲库铵0.2 mg/kg。麻醉维持时,R组患者静脉泵注瑞马唑仑0.4~1.2 mg(/kg·h)+瑞芬太尼0.1~0.2μg(/kg·min);P组患者静脉泵注丙泊酚4~10 mg(/kg·h)+瑞芬太尼0.1~0.2μg(/kg·min);两组患者均间断静脉推注顺阿曲库铵。术中监测患者麻醉深度并据此调整瑞马唑仑、丙泊酚和瑞芬太尼的泵注速度。记录两组患者术中输液量、失血量、手术时间、阿片类药物用量,术后24、72 h时的视觉模拟评分法(VAS)评分;同时,测定麻醉诱导前30 min、术后24 h和术后72 h时两组患者T淋巴群CD3⁺、CD4⁺、CD8⁺和自然杀伤(NK)细胞的水平以及不良反应发生率,并计算CD4⁺/CD8⁺比值;记录两组患者不良反应发生情况。结果:两组患者术中输液量、失血量、手术时间、阿片类药物用量,术后24、72 h时的VAS评分以及不良反应发生率比较,差异均无统计学意义(P>0.05)。与麻醉诱导前30 min比较,两组患者在术后24 h时的CD3⁺、CD4⁺、NK细胞水平和CD4⁺/CD8⁺比值均显著降低(P<0.05);与P组比较,R组患者在术后24 h时的CD3⁺、CD4⁺、NK细胞水平和CD4⁺/CD8⁺比值均显著升高(P<0.05)。结论:用于麻醉维持时,瑞马唑仑对乳腺癌根治术患者围术期细胞免疫的抑制作用小于丙泊酚。

Comparison of the Effects of Remimazolam and Propofol on Perioperative Cellular Immune Function in Patients underwent Radical Mastectomy

OBJECTIVE:To compare the effects of intravenous anesthesia with remimazolam and propofol on perioperative cellular immune function in patients underwent radical mastectomy.METHODS:Eighty patients underwent selective radical mastectomy were collected,and then randomly divided into remimazolam group(group R)and propofol group(group P).During anesthesia induction,group R was intravenously injected with remimazolam 0.2 mg/kg+sufentanil 0.3μg/kg+cisatracurium 0.2 mg/kg;group R was intravenously injected with propofol 2 mg/kg+sufentanil 0.3μg/kg+cisatracurium 0.2 mg/kg.During anesthesia maintenance,group R was intravenously pumped with remimazolam 0.4-1.2 mg/(kg·h)+remifentanil 0.1-0.2μg/(kg·min);group P was intravenously pumped with propofol 4-10 mg/(kg·h)+remifentanil 0.1-0.2μg/(kg·min).Both groups were given intravenous injection of cisatracurium intermittently.The anesthesia depth was monitored during the operation and the pumping speed of remimazolam,propofol and remifentanil was adjusted accordingly.The intraoperative infusion volume,blood loss,operation time,opioid dosage,and visual analogue scale(VAS)scores at 24 and 72 hours after operation were recorded in 2 groups;at the same time,the levels of T lymphocyte CD3⁺,CD4⁺,CD8⁺and NK cells were measured 30 min before anesthesia induction,24 h and 72 h after operation;CD4⁺/CD8⁺was also calculated.The incidence of ADR was recorded in 2 groups.RESULTS:There was no statistical significance in intraoperative infusion volume,blood loss,operation time,opioid dosage,VAS score at 24,72 hours after operation and the incidence of ADR between 2 groups(P>0.05).Compared with 30 min before anesthesia induction,the levels of CD3⁺,CD4⁺,NK cells and CD4⁺/CD8⁺ratio in 2 groups at 24 hours after operation were significantly decreased(P<0.05);compared with group P,the levels of CD3⁺,CD4⁺and NK cells as well as CD4⁺/CD8⁺ratio in group R increased significantly in group R(P<0.05).CONCLUSIONS:For anesthesia maintenance,the inhibitory effects of remimazolam on perioperative cellular immunity in patients underwent radical mastectomy are poorer than propofol.