目的:探讨右美托咪定对乳腺癌根治术患者Th1/Th2细胞因子及免疫功能的影响。方法:选取我院行乳腺癌根治术79例患者进行研究,随机分为观察组和对照组,两组患者常规术前准备,监测心电图、血压、心率、脉搏、血氧饱和度,建立静脉通道,采用维库溴铵、丙泊酚、瑞芬太尼麻醉诱导,观察组麻醉诱导前给予右美托咪定1 μg·kg-1,10 min泵注完毕,随后以0.5 μg·kg-1·h-1持续泵入至手术结束,对照组以等量生理盐水持续泵入至手术结束。两组于麻醉诱导前(T0)、术毕即刻(T1)、术后6 h(T2)、术后24 h(T3)、术后72 h(T4)抽取外周静脉血,采用ELISA法测定白细胞介素-2(IL-2)、白细胞介素-4(IL-4)、白细胞介素-10(IL-10)、干扰素-γ(IFN-γ),计算IFN-γ/IL-4；于T0、T2、T3、T4抽取外周静脉血,采用流式细胞仪测定CD3+、CD4+、CD8+、NK细胞,计算CD4+/CD8+。结果:两组IL-2、IFN-γ在T1、T2、T3、T4时高于T0时,IL-10低于T0时,而观察组IFN-γ/IL-4高于T0时,对照组低于T0时,与T0时相比差异显著(P<0.05),两组各时点IL-4无明显变化；观察组IL-2、IFN-γ、IFN-γ/IL-4在T1、T2、T3、T4时高于对照组,IL-10低于对照组,两组相比差异显著(P<0.05)。两组CD3+、CD4+、CD4+/CD8+、NK细胞在T2、T3时低于T0时,而CD8+无明显变化,与T0时相比差异显著(P<0.05)；观察组CD3+、CD4+、CD4+/CD8+、NK细胞在T2、T3时高于对照组,两组相比差异显著(P<0.05)。结论:右美托咪定能够抑制乳腺癌根治术患者围术期应激反应,纠正Th1/Th2平衡紊乱,提高T淋巴细胞亚群水平,发挥更好的免疫保护功能。
Objective: To investigate the effect of dexmedetomidine on Th1/Th2 cytokines and immune function in patients with breast cancer after radical mastectomy. Methods: In our hospital from July 2016 to July 2017 undergoing radical mastectomy for breast cancer were studied in 79 patients, were randomly divided into observation group and control group, 2 groups of patients with routine preoperative preparation, monitoring blood pressure, electrocardiogram, heart rate, pulse, oxygen saturation, establish vein channel, using propofol, remifentanil, vecuronium induced anesthesia, observation group before induction of anesthesia, dexmedetomidine 1μg . kg-1,0 min after infusion, followed by 0.5μg. kg-1 .h-1 continuous infusion to the end of the operation, the control group with normal saline continuous infusion till the end of the operation. 2 groups of patients before induction of anesthesia (T0), at the end of operation (T1), 6 h after operation (T2), 24 h after operation (T3), 72 h after operation (T4) from peripheral venous blood determination of interleukin -2 by ELISA method (IL-2), interleukin -4 (IL-4), interleukin -10 (IL-10) and interferon gamma (IFN- gamma), calculated IFN- gamma in T0, T2, /IL-4; T3, T4 from peripheral blood was determined by CD3+, CD4+, CD8+, NK, flow cytometry and CD4+/CD8+ calculation. Results:2 groups of IL-2 and IFN- in T1, T2, T3 gamma, T4 is higher than T0, IL-10 less than T0, and the observation group IFN- gamma /IL-4 is higher than T0, the control group was lower than that of T0 when compared with T0 significant difference (P<0.05), 2 in group IL-4 had no obvious changes were observed in group IL-2; IFN-, IFN-, gamma gamma /IL-4 in T1, T2, T3, T4 higher than the control group, IL-10 was lower than the control group, significant difference between the 2 groups (P<0.05). CD3+, CD4+, CD4+/CD8+, NK cells in T2 group was lower than that of T0, T3, and CD8+ had no obvious change, compared with T0 significant difference (P<0.05); the observation group CD3+, CD4+, CD4+/CD8+, T2, T3 in NK cells was higher than the control group, significant difference between the 2 groups (P<0.05). Conclusion: Dexmedetomidine can inhibit the stress response during the perioperative period of radical mastectomy, correct the balance disorder of Th1/Th2, improve the level of T lymphocyte subsets, and exert better immune protection function.