Objective To study the effect of preemptive analgesia with dezocine on perioperative immune function and stress level in patients with breast cancer.Methods Totally 80 female patients with unilateral breast cancer who underwent modified radical mastectomy from February 2012 to October 2014 were randomly divided into dezocine group and control group (40 cases in each group).Patients in dezocine group were administered intravenously with 5 mg of dezocine for preemptive analgesia 15 min before induction;instead,patients in dezocine group were given 5 ml of 0.9％ saline instead was given in control group.The operation duration and intraoperative blood loss were recorded;the T-lymphocyte subsets (CD3+,CD4+ and CD8+) and natural killer cells (NK cells)CD+16 CD+56) were measured by flow cytometry before anesthesia,2 h after incision,24,48,120 h after operation,and the ratio of CD3+/CD4+ subset were calculated;the renin,angiotensin Ⅱ,aldosterone and cortisol in plasma were measured 30 min before anesthesia induction (T0),and 2 h (T1),12 h (T2),24 h (T3),48 h (T4) after operation were detected and compared between groups.Results The levels of CD3+,CD4+ and CD4+/CD8+lymphocyte subset in dezocine group were significantly higher than those in control group 24 h after operation [(52.25±4.75)％ vs (47.79 ±4.40)％,(27.38 ±2.52)％ vs (24.85 ±2.58)％,(1.12±0.18) vs (1.01 ±0.15)] (P ＜0.05).The level of NK cells in dezocine group was significantly higher than that in control group 2 h and 24 h after operation [(14.8 ±2.0)％ vs (13.8 ± 1.5)％,(14.4 ±2.2)％ vs (13.0 ± 1.8)％,P ＜0.05].The levels of plasma renin,angiotensin Ⅱ,aldosterone and cortisol in dezocine group were significantly lower than those in control group 12 and 24 h after operation [12 h:(0.59 ±0.16) μg/L vs (0.72 ±0.15) μg/L,(45 ± 11) μg/L vs (59 ± 12) μg/L,(236 ± 20) μg/L vs (259 ± 24) μg/L,(260 ± 31) μg/L vs (300 ±30) μg/L;24 h:(0.67±0.15) μg/L vs (0.89±0.16) μg/L,(43±10) μg/L vs (57±8) μg/L,(221 ±25) μg/L vs (267 ± 28) μg/L,(265 ± 30) μg/L vs (286 ± 30) μg/L] (P ＜ 0.05).Conclusion Preemptive analgesia with dezocine can protect the T lymphocyte subsets and natual killer cells,thus to promote the recovery of perioperative immune function and reduce the stress response to surgical trauma in patients with breast cancer.%目的 探讨地佐辛超前镇痛对乳腺癌根治术患者围术期免疫功能及应激反应的影响.方法 选取2014年6月至2015年5月在陕西省肿瘤医院进行单侧乳腺癌改良根治术的女性患者80例,使用随机数字表法分为地佐辛组和对照组,各40例.诱导前15 min地佐辛组给予地佐辛5 mg静脉注射作为超前镇痛,对照组给予5 ml 0.9％氯化钠注射液.记录2组患者的手术时间、术中出血量,使用流式细胞仅检测2组患者麻醉前30 min、手术开始后2h、术后24、48、120 h的CD3、CD4+、CD+8 T细胞亚群和自然杀伤(NK)细胞(CD十16CD+56)百分比并计算CD4/CD8比值,于麻醉前30 min、术后2、12、24、48 h使用放射免疫法检测患者血浆肾素、血管紧张素Ⅱ、醛固酮和皮质醇水平.结果 地佐辛组患者术后24 h CD+3、CD+4以及CD+4/CD+8比值均明显高于对照组,差异均有统计学意义[(52.3±4.8)％比(47.8±4.4)％、(27.4±2.5)％比(24.9±2.6)％、(1.12 ±0.18)比(1.01 ±0.15),均P＜0.05];术后2h和术后24 h的NK细胞水平均高于对照组,差异均有统计学意义[(14.8±2.0)％比(13.8±1.5)％、(14.4±2.2)％比(13.0±1.8)％,均P＜0.05].术后12和24 h血浆肾素、血管紧张素Ⅱ、醛固酮、皮质醇浓度均明显低于对照组,差异均有统计学意义[术后12 h:(0.59±0.16) μg/L比(0.72±0.15) μg/L、(45±11) μg/L比(59±12) μg/L、(236±20) μg/L比(259±24) μg/L、(260±31) μg/L比(300±30) μg/L,术后24 h:(0.67±0.15) μg/L比(0.89 ±0.16) μg/L、(43±10) μg/L比(57±8) μg/L、(221±25) μg/L比(267±28) μg/L、(265 ±30) μg/L比(286±30) μg/L,均P＜0.05].结论 乳腺癌根治手术患者围术期使用地佐辛超前镇痛后对T淋巴细胞亚群和NK细胞有保护作用,有利于患者免疫功能的恢复,可减轻手术创伤所产生的应激反应.
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