围术期麻醉与镇痛方式对乳腺癌切除术患者免疫功能的影响
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
The Effects of Perioperative Anesthesia and Analgesia on Immune Function in Patients Undergoing Breast Cancer Resection
背景与目的
围术期麻醉与镇痛可加剧免疫力低下癌症患者的免疫抑制作用，自然杀伤细胞（NK细胞）作为抗肿瘤免疫的固有重要组成部分，在机体的抗肿瘤免疫中起到关键作用，是防止肿瘤扩散的主要防御机制。NK细胞的细胞毒性（NKCC）的降低与乳腺癌、结肠癌和前列腺癌的不良预后有相关性。本研究旨在比较两种不同的麻醉与镇痛方式对乳腺癌切除术患者NKCC的作用。
方 法
本研究为前瞻性随机对照试验，共纳入55名乳腺癌切除术患者，随机分为两组：丙泊酚-氨丁三醇组（术中采用丙泊酚-瑞芬太尼维持麻醉，术后使用氨丁三醇进行镇痛；七氟烷-芬太尼组（术中采用七氟烷-瑞芬太尼维持麻醉，术后使用芬太尼进行镇痛）。主要指标为NKCC:于术前或术后24h测量，其它指标包括术后疼痛评分、白细胞，中性粒细胞和淋巴细胞计数，中性粒细胞 - 淋巴细胞比率（NLR）所评估的炎症反应。术后两年内每6个月进行一次乳腺超声、腹部超声和全身骨扫描评估肿瘤的复发或转移的发生率。
结 果
两组间NKCC（%）的基线没有统计学差异（P = 0.082）；与基线相比，丙泊酚- 酮咯酸氨丁三醇组术后NKCC增加（P = 0.048），而在七氟烷-芬太尼组术后NKCC降低（P = 0.032）。 NKCC随时间的变化在各组之间有显着差异（P = 0.048）；术后48h两组间疼痛评分及免疫反应指标无统计学意义；七氟烷-芬太尼组有1例患者术后对侧乳房发现肿瘤复发而接受部分乳房切除术。两组间手术后两年内发生转移患者数无比较意义。
结 论
与七氟醚麻醉和芬太尼术后镇痛这样的麻醉方式相比，丙泊酚麻醉联合氨丁三醇镇痛对机体NKCC作用更明显，更有利于减轻围术期机体免疫功能抑制，推荐于乳腺癌切除的患者。
原始文献摘要
Jin S C, Lee M H, Kim S I, et al. The Effects of Perioperative Anesthesia and Analgesia on Immune Function in Patients Undergoing Breast Cancer Resection: A Prospective Randomized Study[J]. International Journal of Medical Sciences, 2017, 14(10):970.
Introduction: Perioperative anesthesia and analgesia exacerbate immunosuppression inimmunocompromised cancer patients. The natural killer (NK) cell is a critical part of anti-tumor immunity. We compared the effects of two different anesthesia and analgesia methods on the NK cell cytotoxicity (NKCC) in patients undergoing breast cancer surgery.
Methods: Fifty patients undergoing breast cancer resection were randomly assigned to receive propofol-remifentanil anesthesia with postoperative ketorolac analgesia (Propofol-ketorolac groups) or sevoflurane-remifentanil anesthesia with postoperative fentanyl analgesia (Sevoflurane-fentanyl group). The primary outcome was NKCC, which was measured before and 24 h after surgery. Post-surgical pain scores and inflammatory responses measured by white blood cell, neutrophil, and lymphocyte counts were assessed. Cancer recurrence or metastasis was evaluated with ultrasound and whole body bone scan every 6 months for 2 years after surgery.
Results: The baseline NKCC (%) was comparable between the two groups (P = 0.082). Compared with the baseline value, NKCC (%) increased in the Propofol-ketorolac group [15.2 (3.2) to 20.1 (3.5), P =0.048], whereas it decreased in the Sevoflurane-fentanyl group [19.5 (2.8) to 16.4 (1.9), P = 0.032]. The change of NKCC over time was significantly different between the groups (P = 0.048). Pain scores during 48 h after surgery and post-surgical inflammatory responses were comparable between the groups. One patient in the Sevoflurane-fentanyl group had recurrence in the contralateral breast and no metastasis was found in either group.
Conclusions: Propofol anesthesia with postoperative ketorolac analgesia demonstrated a favorable impact on immune function by preserving NKCC compared with sevoflurane anesthesia and postoperative fentanyl analgesia in patients undergoing breast cancer surgery.
麻醉学文献进展分享