瑞芬太尼对甲状腺手术患者术中、术后NK细胞的影响
发布时间：2018-11-06 17:10
【摘要】：背景：癌症的发生发展与免疫功能失调息息相关。自然杀伤细胞（naturalkiller cell, NK细胞）在负责肿瘤的监督、识别、杀伤及控制感染中起主要作用。已知手术创伤性应激反应与相关的麻醉因素都明显抑制手术期NK细胞活性及数量。部分麻醉药物本身对免疫系统有直接或间接抑制作用，术中、术后镇痛不全会通过激活HPA轴（下丘脑-垂体-肾上腺轴）释放皮质醇等应激激素更进一步抑制免疫功能。既往对麻醉与免疫关系的研究多集中于麻醉药物本身和麻醉方式，而对于在麻醉下癌与非癌症患者的免疫影响未见报道。本实验采用对NK细胞无影响的镇静药丙泊酚及具有免疫保护作用的右美托咪定辅助镇静、复合靶控输注相同血浆靶浓度的瑞芬太尼麻醉，观察实施甲状腺手术的甲状腺癌症患者及非癌症患者行相同的麻醉时术中、术后24小时NK细胞数量变化有无不同。 方法：40名ASA分级I-II级择期行甲状腺手术的患者，麻醉诱导前以负荷量1ug/kg泵入右美托咪定10min后改维持量全程输注，麻醉诱导静注丙泊酚、苯磺酸顺式阿曲库铵及靶控输注瑞芬太尼，麻醉维持采用丙泊酚静脉泵入和瑞芬太尼靶控输注，术中麻醉药物维持剂量及血药浓度根据BIS值及血流动力学指标进行调整。根据患者术中病理结果分成两组，即癌症组和非癌组，，分别于入室时（T1）、插管时（T2）、术毕（T3）、术后24h（T4）抽取外周静脉血利用流式细胞仪检测NK细胞数量、用电化学发光法测皮质醇（COR）数值。 结果：NK细胞结果显示：两组术前（T1）18.85±4.15与15.79±4.64均在正常范围，组间比较无统计学差异；癌症组诱导后插管时（T2）10.52±5.32与术前（T1）18.85±4.15组内比较、非癌症组（T2）9.91±2.34与术前（T1）15.79±4.64组内比较均有统计学差异（P0.05）；癌症组术毕（T3）15.49±7.10与T210.52±5.32组内比较、与非癌组T37.21±4.04组间比较均有统计学差异（P0.05）；癌症组术后24小时（T4）10.56±2.85与T118.85±4.15及T315.49±7.10组内比较均有统计学差异（p0.05）；非癌组T414.73±5.12与T115.79±4.64组内比较无统计学差异，与T37.21±4.04比较有统计学差异（p0.05）；两组T410.56±2.85与14.73±5.12组间比较有统计学差异（p0.05）。COR结果显示： T1时癌症组671.33±15.45与非癌症组472.23±19.36组间比较有统计学差异（p0.05）,T2时癌症组498.56±14.75与非癌症组350.25±14.96组间比较有统计学差异（p0.05），总体数值显示癌症组各时间点COR数值略高于非癌症组。 结论：7ng/ml瑞芬太尼靶控输注对甲状腺癌和良性肿物患者术中NK细胞数目均有抑制作用，这种抑制作用在非癌症患者术后24小时恢复至术前水平，而癌症患者NK细胞的抑制作用持续至术后24小时仍未恢复，但这种抑制一部分归结于手术因素，另外亦不排除癌症患者本身对瑞芬太尼导致的NK细胞的抑制作用恢复较差。
[Abstract]:Background: the occurrence and development of cancer is closely related to immune dysfunction. Natural killer cells (naturalkiller cell, NK cells) play a major role in tumor surveillance, identification, killing and control of infection. All known traumatic stress responses and related anesthetic factors significantly inhibited the activity and number of NK cells during surgery. Part of the anesthetic itself has direct or indirect inhibitory effect on the immune system. During the operation, postoperative analgesia is not complete by activating the HPA axis (hypothalamus-pituitary-adrenal axis) release of cortisol and other stress hormones to further inhibit the immune function. Previous studies on the relationship between anesthesia and immunity have focused on the anesthetic drugs themselves and anaesthesia methods, but the immune effects on cancer and non-cancer patients under anesthesia have not been reported. In this experiment, propofol, a sedative agent with no effect on NK cells, and dexmetomidine, which has immune protective effect, were used to assist sedation, and remifentanil with the same plasma target concentration was administered by target controlled infusion. To observe the changes of the number of NK cells 24 hours after thyroidectomy in patients with thyroid cancer and non-cancer patients undergoing the same anesthesia. Methods: 40 ASA grade I-II patients undergoing selective thyroid surgery were injected with load 1ug/kg before anesthesia induction and then injected with dexmetomidine 10min. Propofol was injected intravenously after anesthesia induction, and propofol was injected intravenously. The anesthesia was maintained by intravenous infusion of propofol and target controlled infusion of remifentanil. The maintenance dose and blood concentration of the anesthetic were adjusted according to BIS and hemodynamic indexes. The patients were divided into two groups according to the pathological results during operation: cancer group and non-cancer group. The number of NK cells was detected by flow cytometry at the time of entry (T1), intubation (T2), the end of operation (T3), and 24 hours after operation (T4). The (COR) value of cortisol was measured by electrochemiluminescence. Results: the results of NK cells showed that before operation (T1) 18.85 卤4.15 and 15.79 卤4.64 in normal range, there was no statistical difference between the two groups. There were significant differences between the cancer group (T _ 2) 10.52 卤5.32 and preoperative (T _ 1) 18.85 卤4.15, and the non-cancer group (T _ 2) 9.91 卤2.34 and preoperative (T _ 1) 15.79 卤4.64 (P0.05). After operation (T3) 15.49 卤7.10 and T210.52 卤5.32 in cancer group, there were significant differences between T37.21 卤4.04 and T37.21 卤4.04 groups (P0.05). 24 hours after operation (T4) 10.56 卤2.85 in cancer group, T118.85 卤4.15 and T315.49 卤7.10 in T315.49 卤7.10 group, there were significant differences (p0.05). There was no statistical difference between T414.73 卤5.12 and T115.79 卤4.64 in non-cancer group, but there was statistical difference between T37.21 卤4.04 and T37.21 卤4.04 (p0.05). There was significant difference between the two groups in T410.56 卤2.85 and 14.73 卤5.12 (p0.05). COR). The results showed that there was significant difference between the cancer group (671.33 卤15.45) and the non-cancer group (472.23 卤19.36) at T1 (p0.05). There was statistical difference between cancer group (498.56 卤14.75) and non-cancer group (350.25 卤14.96) at T2. The total value of COR in cancer group was slightly higher than that in non-cancer group. Conclusion: target-controlled infusion of 7ng/ml remifentanil can inhibit the number of NK cells in thyroid carcinoma and benign tumor patients during operation, and the inhibitory effect is restored to the preoperative level 24 hours after operation in non-cancer patients. However, the inhibition of NK cells in cancer patients did not recover until 24 hours after operation, but the inhibition was partly attributed to surgical factors, and it was not excluded that the inhibition of remifentanil induced NK cells in cancer patients was poor.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
本文编号：2314920
[Abstract]:Background: the occurrence and development of cancer is closely related to immune dysfunction. Natural killer cells (naturalkiller cell, NK cells) play a major role in tumor surveillance, identification, killing and control of infection. All known traumatic stress responses and related anesthetic factors significantly inhibited the activity and number of NK cells during surgery. Part of the anesthetic itself has direct or indirect inhibitory effect on the immune system. During the operation, postoperative analgesia is not complete by activating the HPA axis (hypothalamus-pituitary-adrenal axis) release of cortisol and other stress hormones to further inhibit the immune function. Previous studies on the relationship between anesthesia and immunity have focused on the anesthetic drugs themselves and anaesthesia methods, but the immune effects on cancer and non-cancer patients under anesthesia have not been reported. In this experiment, propofol, a sedative agent with no effect on NK cells, and dexmetomidine, which has immune protective effect, were used to assist sedation, and remifentanil with the same plasma target concentration was administered by target controlled infusion. To observe the changes of the number of NK cells 24 hours after thyroidectomy in patients with thyroid cancer and non-cancer patients undergoing the same anesthesia. Methods: 40 ASA grade I-II patients undergoing selective thyroid surgery were injected with load 1ug/kg before anesthesia induction and then injected with dexmetomidine 10min. Propofol was injected intravenously after anesthesia induction, and propofol was injected intravenously. The anesthesia was maintained by intravenous infusion of propofol and target controlled infusion of remifentanil. The maintenance dose and blood concentration of the anesthetic were adjusted according to BIS and hemodynamic indexes. The patients were divided into two groups according to the pathological results during operation: cancer group and non-cancer group. The number of NK cells was detected by flow cytometry at the time of entry (T1), intubation (T2), the end of operation (T3), and 24 hours after operation (T4). The (COR) value of cortisol was measured by electrochemiluminescence. Results: the results of NK cells showed that before operation (T1) 18.85 卤4.15 and 15.79 卤4.64 in normal range, there was no statistical difference between the two groups. There were significant differences between the cancer group (T _ 2) 10.52 卤5.32 and preoperative (T _ 1) 18.85 卤4.15, and the non-cancer group (T _ 2) 9.91 卤2.34 and preoperative (T _ 1) 15.79 卤4.64 (P0.05). After operation (T3) 15.49 卤7.10 and T210.52 卤5.32 in cancer group, there were significant differences between T37.21 卤4.04 and T37.21 卤4.04 groups (P0.05). 24 hours after operation (T4) 10.56 卤2.85 in cancer group, T118.85 卤4.15 and T315.49 卤7.10 in T315.49 卤7.10 group, there were significant differences (p0.05). There was no statistical difference between T414.73 卤5.12 and T115.79 卤4.64 in non-cancer group, but there was statistical difference between T37.21 卤4.04 and T37.21 卤4.04 (p0.05). There was significant difference between the two groups in T410.56 卤2.85 and 14.73 卤5.12 (p0.05). COR). The results showed that there was significant difference between the cancer group (671.33 卤15.45) and the non-cancer group (472.23 卤19.36) at T1 (p0.05). There was statistical difference between cancer group (498.56 卤14.75) and non-cancer group (350.25 卤14.96) at T2. The total value of COR in cancer group was slightly higher than that in non-cancer group. Conclusion: target-controlled infusion of 7ng/ml remifentanil can inhibit the number of NK cells in thyroid carcinoma and benign tumor patients during operation, and the inhibitory effect is restored to the preoperative level 24 hours after operation in non-cancer patients. However, the inhibition of NK cells in cancer patients did not recover until 24 hours after operation, but the inhibition was partly attributed to surgical factors, and it was not excluded that the inhibition of remifentanil induced NK cells in cancer patients was poor.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
【参考文献】
相关期刊论文 前1条
1 耿志宇,宋琳琳,许幸,吴新民;异丙酚复合芬太尼或瑞芬太尼靶控静脉麻醉与静吸复合麻醉的比较[J];中华麻醉学杂志;2004年01期
本文编号：2314920
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