Objective To observe the effect of dexmedetomidine on the the perioperative stress hormones and cellular immune in patients underwent radical mastectomy.Methods 50 breast cancer patients underwent radical surgery were randomly divided into the control group (25 case) and the experimental groups (25 case).The experimental group were given intravenous pumping of dexmedetomidine 15 minutes before anesthesia induction ,and continuous intravenous pumping of dexmedetomidine af-ter intubation of anesthesia induction.The control group were given the same amount of saline instead of dexmedetomidine ,and the rest was the same as the experimental group.Flow cytometry induction was used to detect peripheral blood T lymphocyte subsets in the cluster of differentiation antigens,helper T cells,and regulatory T cells before anesthesia (T0),6 h after surgery (T1),1 d af-ter surgery ( T2 ) ,2 d after surgery ( T3 ) and 3 d after surgery ( T4 ).And enzyme-linked immunosorbent quantitative was used to detect levels of stress hormones 1 d,3 d,5 d before surgery.Results The level of lymphocyte had no statistical differences at T 0 between the 2 groups(P>0.05).The level of lymphocyte at T2,T3 when compared with T0 were significantly lower in the control group,Treg at T2,T3 was significantly higher than before (P<0.05) in the control group.The exprimental group at each time point had no significant differences.Compared with the control group at the same time point ,CD4,CD4/CD8,Th1 and Th1/Th2 of the experiment group increased significantly at T 2 and T3 ,and Treg increased significantly.The stress hormones showed no signifi-cant difference between the 2 groups before the surgery ,the stress hormones in the expriment group 1 d,3 d,5 d after the surgery was significantly lower than those of the control group (P<0.05).Conclusion The cellular immune function is attenualed after radical mastectomy.Suppression with continuous intravenous infusion of dexmedetomidine may effectively reduce the perioperative stress and reduce the inhibition of cellular immune function in patients underwent radical mastectomy.%目的 观察右美托咪定对乳腺癌根治手术患者围术期应激反应激素及术后细胞免疫的影响. 方法 选取2011年3月至2014年3月采用根治手术治疗的乳腺癌患者50例,随机分为对照组( 25例)和实验组( 25例). 实验组于麻醉诱导前15 min内静脉泵入右美托咪定,麻醉诱导插管后,持续静脉输入右美托咪定. 对照组用等量的生理盐水代替右美托咪定,其余均与实验组相同. 采用流式细胞术检测麻醉诱导前(T0)、术毕6 h(T1)、术后1 d(T2)、术后2 d (T3)和术后3 d(T4)外周血T淋巴细胞亚群中簇分化抗原、辅助性T细胞、调节性T细胞水平. 采用酶联免疫定量检测的方法进行术前、术后1d、3d、5d应激激素含量的检测. 结果 2组在T0 的淋巴细胞亚群水平差异无统计学意义(P>0.05). 在对照组中T2、T3 时与T0 时比较均显著降低,Treg在T2、T3 时显著升高(P<0.05),实验组各时间点均无明显变化. 与对照组同一时间点比较,实验组T2 和T3 时CD4 +、CD4 +/CD8 +、Th1和Th1/Th2显著升高,Treg显著升高. 而在术前对照组与实验组应激激素差异无统计学意义,术后1 d、3 d、5 d实验组应激激素明显低于对照组( P<0.05). 结论 乳腺癌根治术患者在术后存在短暂的细胞免疫抑制状态,全麻状态下静脉注射右美托咪定能够有效抑制患者在围术期的应激反应,减轻术后细胞免疫功能的抑制.
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