Page 102 - 《中国药房》2021年07期

·药物与临床·

瑞马唑仑与丙泊酚对乳腺癌根治术患者围术期细胞免疫功能的

影响比较 Δ

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李亚琦 ，李晓曦 ，缪长虹 ，卢锡华 ，李长生 （1.郑州大学附属肿瘤医院麻醉与围术期医学科，郑州 450008；
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2.复旦大学附属中山医院麻醉科，上海 200032）
中图分类号 R614；R737.9 文献标志码 A 文章编号 1001-0408（2021）07-0860-05
DOI 10.6039/j.issn.1001-0408.2021.07.15
摘 要 目的：比较瑞马唑仑与丙泊酚静脉麻醉对乳腺癌根治术患者围术期细胞免疫功能的影响。方法：将择期行乳腺癌根治术
的患者80例，采用随机数字表法分为瑞马唑仑组（R组）和丙泊酚组（P组）。麻醉诱导时，R组患者静脉推注瑞马唑仑0.2 mg/kg+
舒芬太尼0.3 μg/kg+顺阿曲库铵0.2 mg/kg；P组患者静脉推注丙泊酚2 mg/kg+舒芬太尼0.3 μg/kg+顺阿曲库铵0.2 mg/kg。麻醉维
持时，R组患者静脉泵注瑞马唑仑0.4～1.2 mg/（kg·h）+瑞芬太尼0.1～0.2 μg/（kg·min）；P组患者静脉泵注丙泊酚4～10 mg/（kg·h）+
瑞芬太尼0.1～0.2 μg/（kg·min）；两组患者均间断静脉推注顺阿曲库铵。术中监测患者麻醉深度并据此调整瑞马唑仑、丙泊酚和
瑞芬太尼的泵注速度。记录两组患者术中输液量、失血量、手术时间、阿片类药物用量，术后24、72 h时的视觉模拟评分法（VAS）
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评分；同时，测定麻醉诱导前30 min、术后24 h和术后72 h时两组患者T淋巴群CD3 、CD4 、CD8 和自然杀伤（NK）细胞的水平以
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及不良反应发生率，并计算CD4 /CD8 比值；记录两组患者不良反应发生情况。结果：两组患者术中输液量、失血量、手术时间、阿
片类药物用量，术后24、72 h时的VAS评分以及不良反应发生率比较，差异均无统计学意义（P＞0.05）。与麻醉诱导前30 min比较，
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两组患者在术后24 h时的CD3 、CD4 、NK细胞水平和CD4 /CD8 比值均显著降低（P＜0.05）；与P组比较，R组患者在术后24 h时的
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CD3 、CD4 、NK细胞水平和CD4 /CD8 比值均显著升高（P＜0.05）。结论：用于麻醉维持时，瑞马唑仑对乳腺癌根治术患者围术期
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细胞免疫的抑制作用小于丙泊酚。
关键词 麻醉；丙泊酚；瑞马唑仑；细胞免疫；乳腺癌根治术
Comparison of the Effects of Remimazolam and Propofol on Perioperative Cellular Immune Function in
Patients underwent Radical Mastectomy
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LI Yaqi ，LI Xiaoxi ，MIAO Changhong ，LU Xihua ，LI Changsheng（1. Dept. of Anesthesia and Perioperative
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Medicine，the Affiliated Cancer Hospital of Zhengzhou University，Zhengzhou 450008，China；2. Dept. of
Anesthesia，the Affiliated Zhongshan Hospital of Fudan University，Shanghai 200032，China）
ABSTRACT OBJECTIVE：To compare the effects of intravenous anesthesia with remimazolam and propofol on perioperative
cellular immune function in patients underwent radical mastectomy. METHODS：Eighty patients underwent selective radical
mastectomy were collected，and then randomly divided into remimazolam group（group R）and propofol group（group P）. During
anesthesia induction，group R was intravenously injected with remimazolam 0.2 mg/kg + sufentanil 0.3 μ g/kg + cisatracurium 0.2
mg/kg；group R was intravenously injected with propofol 2 mg/kg+sufentanil 0.3 μg/kg+cisatracurium 0.2 mg/kg. During anesthesia
maintenance，group R was intravenously pumped with remimazolam 0.4-1.2 mg/（kg·h）+remifentanil 0.1-0.2 μg/（kg·min）；group P
was intravenously pumped with propofol 4-10 mg/（kg·h）+remifentanil 0.1-0.2 μg/（kg·min）. Both groups were given intravenous
injection of cisatracurium intermittently. The anesthesia depth was monitored during the operation and the pumping speed of
remimazolam，propofol and remifentanil was adjusted accordingly. The intraoperative infusion volume，blood loss，operation time，
opioid dosage，and visual analogue scale（VAS）scores at 24 and 72 hours after operation were recorded in 2 groups；at the same
time，the levels of T lymphocyte CD3 ，CD4 ，CD8 and NK cells were measured 30 min before anesthesia induction，24 h and 72
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h after operation；CD4 /CD8 was also calculated. The incidence of ADR was recorded in 2 groups. RESULTS：There was no
statistical significance in intraoperative infusion volume，blood loss，operation time，opioid dosage，VAS score at 24，72 hours
after operation and the incidence of ADR between 2 groups（P＞0.05）. Compared with 30 min before anesthesia induction，the
levels of CD3 ，CD4 ，NK cells and CD4 /CD8 ratio in 2 groups at 24 hours after operation were significantly decreased（P＜
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0.05）；compared with group P，the levels of CD3 ，CD4 and NK cells as well as CD4 /CD8 ratio in group R increased
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significantly in group R （P＜0.05）. CONCLUSIONS： For
Δ 基金项目：国家自然科学基金资助项目（No.81870882）
＊硕士研究生。研究方向：围术期临床麻醉管理。电话：0371- anesthesia maintenance，the inhibitory effects of remimazolam
65588327。E-mail：liyaqi21@126.com on perioperative cellular immunity in patients underwent
# 通信作者：主任医师，博士生导师，博士。研究方向：围术期临 radical mastectomy are poorer than propofol.
床麻醉管理和术后认知功能障碍。电话：0371-65588327。E-mail： KEYWORDS Anesthesia；Propofol；Remimazolam；Cellular
lihan159@126.com immunity；Radical mastectomy
·860 · China Pharmacy 2021 Vol. 32 No. 7 中国药房 2021年第32卷第7期