摘要
目的 探究静吸复合麻醉对乳腺癌改良根治术病人免疫抑制及血清β淀粉样蛋白-42(Aβ-42)/tau蛋白、神经元特异性烯醇化酶(NSE)、脑源性神经营养因子(BDNF)水平的影响。方法 选取辽宁省健康产业集团阜新矿总医院2016年5月至2019年9月收治的乳腺癌病人106例作为研究对象,按照随机数字表法分组,各53例。两组均行乳腺癌改良根治术,对照组采取全凭静脉麻醉,观察组采取静脉麻醉+吸入麻醉的复合麻醉。比较两组麻醉前(T_(0))、麻醉后5 min(T_(1))、切皮时(T_(2))、腋窝淋巴清扫时(T_(3))、术毕(T_(4))血流动力学[平均动脉压(MAP)、心率(HR)]、术后12 h、24 h、48 h镇痛效果(VAS)评分、免疫抑制情况(CD3^(+)、CD4^(+)、CD8^(+))、血清[Aβ-42/tau、NSE、BDNF]水平、认知功能(MMSE)评分及苏醒质量。结果 观察组术后12 h、24 h、48h CD3^(+)(64.44±7.08)%、(70.06±6.89)%、(74.14±7.07)%、CD4^(+)(35.33±6.05)%、(38.22±5.93)%、(41.13±5.13)%高于对照组(57.15±6.64)%、(62.83±6.25)%、(68.04±6.29)%、(28.12±5.41)%、(31.80±5.35)%、(36.39±5.05)%,CD8^(+)(35.15±4.63)%、(32.16±4.37)%、(30.32±4.22)%低于对照组(30.32±4.22)%、(36.91±4.68)%、(34.81±4.34)%(P<0.05);观察组术后12 h、24 h、48 h血清Aβ-42/tau(2.10±0.30)、(2.42±0.35)、(2.42±0.35)、BDNF(21.17±3.21)ng/L、(25.30±3.27)ng/L、(30.17±3.68)ng/L高于对照组(1.82±0.28)、(2.06±0.37)、(2.42±0.40)、(18.21±2.98)ng/L、(22.05±3.05)ng/L、(26.25±3.18)ng/L,NSE(18.26±3.11)μg/L、(14.14±3.03)μg/L、(11.07±2.64)μg/L低于对照组(21.84±3.87)μg/L、(17.84±3.62)μg/L、(13.90±3.07)μg/L(P<0.05);观察组术后12 h、24 h、48 h VAS评分(2.45±0.44)分、(1.78±0.30)分、(1.41±0.32)分低于对照组(3.04±0.57)分、(2.11±0.42)分、(1.85±0.45)分,MMSE评分(24.14±1.82)分、(26.69±2.00)分、(28.32±1.05)分高于对照组(22.06±1.53)分、(24.41±1.75)分、(26.04±1.48)分(P<0.05);观察组自主呼吸恢复时间、拔管时间、定向力恢复时间短于对照组(P<0.05)。结论 静吸复合麻醉应用于乳腺癌改良根治术病人能减轻免疫抑制及神经损伤,促进认知功能恢复,且镇痛效果及苏醒质量较好。
Objective To investigate the effects of intravenous inhalation anesthesia on immunosuppression and the levels of serum amyloid-42 (Aβ-42)/tau protein,neuron-specific enolase (NSE),and brain-derived neurotrophic factor (BDNF) in patients with breast cancer treated with modified radical mastectomy.Methods A total of 106 breast cancer patients admitted to the General Hospital of Fuxin Mining Industry Group of Liaoning Health Industry Group from May 2016 to September 2019 were selected as the research subjects,and were grouped according to the random number table method,with 53 cases in each group.Both groups underwent modified radical mastectomy for breast cancer,the control group received total intravenous anesthesia,and the observation group received combined intravenous anesthesia+inhalation anesthesia.The hemodynamic indexes[mean arterial pressure (MAP) and heart rate (HR)]were compared between the two groups before anesthesia (T_(0)),5 min after anesthesia (T_(1)),skin incision (T_(2)),axillary lymph dissection(T_(3)),and surgery completion (T_(4)).Meanwhile,the analgesic effect (VAS) scores,immunosuppression (CD3^(+),CD4^(+),CD8^(+)),serum[β-amyloid-42 (Aβ-42)/tau protein,neuron-specific enolase (NSE),brain-derived neurotrophic factor (BDNF)]levels,cognitive function(MMSE) score and recovery quality at 12 h,24 h,and 48 h after operation were compared between the two groups.Results At 12 h,24h,and 48 h after operation in the observation group,the levels of CD3^(+)[(64.44±7.08)%,(70.06±6.89)%,(74.14±7.07)%],and CD4^(+)[(35.33±6.05)%,(38.22±5.93)%,(41.13±5.13)%]were higher than those of the control group[(57.15±6.64)%,(62.83±6.25)%,(68.04±6.29)%;(28.12±5.41)%,(31.80±5.35)%,(36.39±5.05)%],CD8^(+)levels[(35.15±4.63)%,(32.16±4.37)%,(30.32±4.22)%]were lower than those of the control group[(30.32±4.22)%,(36.91±4.68)%,(34.81±4.34)%](P<0.05).At 12 h,24 h,and 48 h after operation in the observation group,the levels of serum Aβ-42/tau[(2.10±0.30),(2.42±0.35),(2.42±0.35)],BDNF[(21.17±3.21) ng/L,(25.30±3.27) ng/L,(30.17±3.68) ng/L]were higher than those of the control group[(1.82±0.28),(2.06±0.37),(2.42±0.40);(18.21±2.98) ng/L,(22.05±3.05) ng/L,(26.25±3.18) ng/L],and NSE[(18.26±3.11)μg/L,(14.14±3.03)μg/L,(11.07±2.64)μg/L]were lower than those of the control group[(21.84±3.87)μg/L,(17.84±3.62)μg/L,(13.90±3.07)μg/L](P<0.05);At 12 h,24 h,and 48 h after operation in the observation group,the VAS score[(2.45±0.44) points,(1.78±0.30) points,(1.41±0.32) points]were lower than those in the control group[(3.04±0.57) points,(2.11±0.32) points,(1.85±0.45) points],MMSE scores[(24.14±1.82) points,(26.69±2.00) points,(28.32±1.05) points]were higher than those of the control group[(22.06±1.53) points,(24.41±1.75) points,(26.04±1.48) points](P<0.05).The recovery timse of spontaneous breathing,extubation and orientation in the observation group were shorter than those in the control group (P<0.05).Conclusion Intravenous inhalation anesthesia applied to patients undergoing modified radical mastectomy for breast cancer can reduce immunosuppression and nerve damage,promote cognitive function recovery,and have better analgesic effects and recovery quality.
作者
李斌
姜义
于奇
LI Bin;JIANG Yi;YU Qi(Department of Anesthesiology,General Hospital of Fuxin Mining Industry Group of Liaoning Health Industry Group,Fuxin,Liaoning 123000,China)
出处
《安徽医药》
CAS
2022年第4期723-728,共6页
Anhui Medical and Pharmaceutical Journal
关键词
乳腺肿瘤
乳房切除术
改良根治性
麻醉
吸入
麻醉
静脉
二异丙酚
七氟醚
免疫抑制
神经损伤
Breast neoplasm
Mastectomy
modified radical
Anesthesia
inhalation
Anesthesia
intravenous
Propofol
Sevoflurane
Immunosuppression
Nerve damage
