右美托咪定对乳腺癌根治手术患者应激反应及细胞免疫的影响

目的：探讨右美托咪定对乳腺癌根治手术患者围手术期应激反应及术后细胞免疫的影响。方法选择2012年1月至2015年6月在我院择期全身麻醉下行乳腺癌根治术的患者108例，采用随机数字表法分为右美托咪定组（D 组）和对照组（C 组），每组54例。D 组麻醉前15 min 内静脉滴注右美托咪定1．0μg／kg，麻醉诱导插管后，以0．5μg．kg －1．h －1维持至术毕。C 组给予等容量的生理盐水代替右美托咪定，其余麻醉同 D 组。分别测定麻醉前（T0）、术后4 h（T1）、术后1 d（T2）、术后3 d（T3）和术后7 d（T4）的血浆去甲肾上腺素（NE）、肾上腺素（E）、皮质醇（COR）、血清白细胞介素（IL）-6、T 淋巴细胞亚群（CD3＋、CD4＋、CD8＋、CD4＋／CD8＋）及 NK 细胞的水平。结果与 T0时比较，D 组各点血浆 NE、E、COR 及血清 IL-6水平差异无统计学意义（均 P ＞0．05）。C 组 T1～T3时血浆 NE、E，T2、T3时血浆COR，T2～T4时血清 IL-6水平均显著升高（均 P ＜0．05）。与 C 组比较，D 组 T1～T3时血浆 NE、E，T2和T3时血浆 COR，T2～T4时血清 IL-6水平均明显降低（均 P ＜0．05）。与 T0比较，T1～T3时两组 CD3＋及NK 细胞水平明显降低（均 P ＜0．05）。与 C 组比较，D 组 T1～T3时 CD3＋、NK 细胞明显升高，D 组 T2～T3时 CD4＋及 CD4＋／CD8＋明显升高（P ＜0．05）。结论全身麻醉期间持续静脉滴注右美托咪定可有效减轻乳腺癌根治术患者围手术期的应激反应，改善机体免疫状态。

Effect of dexmedetomidine on perioperative stress reaction and cellular immunity of patients with breast cancer radical surgery

Objective To study the effect of dexmedetomidine on perioperative stress reaction and postoperative cellular immunity of patients with breast cancer radical surgery.Methods We selected 108 cases of breast cancer patients undergoing elective radical surgery under general anesthesia in our hospital from Janu-ary 2012 to June 2015.These patients were divided into dexmedetomidine group (group D)and the control group (group C)by random number table method,54 cases in each group.Patients in group D were given dexmedetomidine 1.0 μg/kg by intravenous drip within 15 min before anesthesia and maintained 0.5 μg.kg -1 .h -1 after anesthesia induction intubation until operation finish.Patients in group C were given the same capacity of normal saline instead of dexmedetomidine,and the rest of the anesthesia was same as group D.The plasma norepinephrine (NE)and epinephrine (E)and cortisol (COR),serum interleukin-6 and T lymphocyte subsets (CD3 +,CD4 +,CD8 +,CD4 +/CD8 +)and NK cells levels were determined before anes-thesia (T0 ),postoperative 4 h (T1 ),1 d (T2 ),3 d (T3 ),and 7 d (T4 ).Results The level of plasma NE, E,COR and serum IL-6 of the D group in different time had no statistical significance compared with T0 time (P ﹥ 0.05).The plasma level of E and NE in T1 -T3 ,plasma COR in T2-T3 and serum IL-6 in T2-T4 of the C group were increased significantly (P ﹤ 0.05).The level of plasma E and NE in T1 -T3 ,plasma COR in T2-T3 and serum IL-6 in T2-T4 of the D group were decreased significantly compared with C group (P ﹤ 0.05).The level of CD3 + and NK cells in T1 -T3 of the two groups decreased significantly compared with T0 (P ﹤ 0.05).The level of NK and CD3 + in T1 -T3 and CD4 +,CD4 +/CD8 + in T2-T3 of group D increased significantly com-pared with group C (P ﹤ 0.05).Conclusion Dexmedetomidine of intravenous drip during general anesthesia can effectively reduce stress reaction in perioperative period of breast cancer patients,and improve patients immune status.