CAJ | 학술논문

目的：评价右美托咪定对乳腺癌根治术后布托啡诺患者自控静脉镇痛（PCIA）时细胞免疫功能的影响。方法择期乳腺癌改良根治术患者60例，女性，ASA分级Ⅱ级，年龄36～60岁，体重48～82 kg，随机分为右美托咪定组（D 组）和对照组（C 组）。全麻诱导后 D 组于麻醉诱导开始前泵入右美托咪定0.5μg/kg，10 min 泵完，C 组于同一时点给予等量生理盐水，麻醉诱导和维持用药一致，术后两组患者静脉镇痛用药方案相同。于麻醉前（T0）、切皮后2 h（T1）、术后6 h（T2）、术后24 h（T3）、术后3 d（T4）、术后7 d（T5）六个时点抽静脉血，采用流式细胞仪检测T淋巴细胞亚群（CD3＋CD4＋CD8＋）及NK细胞。记录术后48 h 内有效按压次数、布托啡诺总消耗量和不良反应发生情况。结果与C组比较，D组T3时CD3＋、CD4＋、CD4＋/CD8＋水平降低，T3时NK细胞水平降低（P＜0.05）。与C组比较，D组48 h内有效按压次数明显减少（P＜0.05），D组48 h 布托啡诺总消耗量减少明显减少（P＜0.05），D组嗜睡发生率差异有统计学意义（P＜0.05）。结论右美托咪定可降低布托啡诺PCIA用量，改善乳腺癌根治术患者术后细胞免疫功能。
목적：평개우미탁미정대유선암근치술후포탁배낙환자자공정맥진통（PCIA）시세포면역공능적영향。방법택기유선암개량근치술환자60례，녀성，ASA분급Ⅱ급，년령36～60세，체중48～82 kg，수궤분위우미탁미정조（D 조）화대조조（C 조）。전마유도후 D 조우마취유도개시전빙입우미탁미정0.5μg/kg，10 min 빙완，C 조우동일시점급여등량생리염수，마취유도화유지용약일치，술후량조환자정맥진통용약방안상동。우마취전（T0）、절피후2 h（T1）、술후6 h（T2）、술후24 h（T3）、술후3 d（T4）、술후7 d（T5）륙개시점추정맥혈，채용류식세포의검측T림파세포아군（CD3＋CD4＋CD8＋）급NK세포。기록술후48 h 내유효안압차수、포탁배낙총소모량화불량반응발생정황。결과여C조비교，D조T3시CD3＋、CD4＋、CD4＋/CD8＋수평강저，T3시NK세포수평강저（P＜0.05）。여C조비교，D조48 h내유효안압차수명현감소（P＜0.05），D조48 h 포탁배낙총소모량감소명현감소（P＜0.05），D조기수발생솔차이유통계학의의（P＜0.05）。결론우미탁미정가강저포탁배낙PCIA용량，개선유선암근치술환자술후세포면역공능。
Objective To investigate the influence of dexmedetomidine on cellular immune function during PCIA with butorphanol in patients undertaken modified radical mastectomy. Methods According to American society of Anesthesiologists (ASA) grade, sixty patients with ASAⅠor Ⅱ scheduled for elective modified radical mastectomy under general anesthesia were randomly divided into 2 groups(n=30 each): the dexmedetomidine group (group D, n=30)and the control group(group C, n=30). In group D, the dexmedetomidine was pumped 0.5 μg/kg before the induce of anesthesia and finished within 10 min. In group C, the saline was pumped at the same speed and time. Anesthesia was maintained with the same drugs in both group. The program after intravenous analgesia of the two group patients is same. the venous blood was drawn at 5 min before the induction of anesthesia(T0), at 2 h after incision(T1), 6 h, 24 h, 3 d, 7 d, after operation(T2, T3, T4, T5), T-lymphocyte subsets(CD3+, CD4+, CD8+) and natural killer cells were measured by flow cytometry at six time points. Effective pressing numbers, butorphanol consumption, and adverse effects were recorded in 48 h after operation. Results Compared with the group C, the level of CD3+, CD4+, CD4+/CD8+ decreased at T3 in group D(P<0.05), the level of NK decreased at T3 in group D (P<0.05). Compared with the group C, the effective pressing numbers greatly reduced in group D(P<0.05), butorphanol requirements greatly reduced in group C in 48 h after surgery. The sleepiness rate in group C was much higher than that in group D(P<0.05). Conclusion Dexmedetomidine can reduce butorphanol requirements during PCIA with butorphanol and improve cellular immune function in patients undertaken modified radical mastectomy.