伤害感受水平指数指导瑞芬太尼输注靶浓度对接受乳腺癌根治术患者细胞免疫和缺氧诱导因子-1α的影响

doi:10.3969/j.issn.1006-5725.2024.18.010

Abstract

Abstract:

Objective To investigate the impact of nociceptive level （NOL） index on cellular immunity and HIF-1α in patients with radical breast cancer. Methods A total of 80 patients undergoing radical mastectomy between December 2022 and December 2023 were randomly assigned into an experimental group and a control group using a random number table method. The NOL index in the experimental group was maintained within the range of 30 to 50， with corresponding adjustments made to achieve the target concentration of remifentanil. In contrast， the control group initially received remifentanil at a target controlled infusion rate of 4 ng/mL， which was adjusted based on hemodynamics. The average target concentration of remifentanil was recorded for both groups. Venous blood samples were collected from all participants one day before and one day after surgery to measure CD4⁺， CD8⁺ cell counts， NK cell activity， as well as serum levels of HIF-1α. Results There were no significant differences observed in anesthesia time， operation time， intraoperative mean arterial pressure （MAP）， heart rate （HR）， and postoperative visual analog scale （VAS） scores between the two groups. The average target concentration of remifentanil in the experimental group was significantly lower than that in the control group （P < 0.05）. Moreover， the experimental group exhibited higher values of CD4⁺， CD4⁺/CD8⁺ ratio， and NK cells compared to the control group， while demonstrating a lower level of HIF-1α expression （P < 0.05）. In addition， within the experimental group， there was a decrease in CD4⁺ count and CD4⁺/CD8⁺ ratio one day after surgery compared to one day before surgery； meanwhile， HIF-1α expression increased significantly after surgery when compared to preoperative levels （P < 0.05）. Similarly， within the control group， there was a decrease observed in CD4⁺， CD8⁺， CD4⁺/CD8⁺ ratio as well as NK cell values one day after surgery when compared to preoperative levels； additionally， HIF-1α expression showed a significant increase after surgery when compared to preoperative levels（P < 0.05）. Conclusion The implementation of NOL monitoring during radical mastectomy under general anesthesia can effectively lower the required remifentanil concentration， thereby mitigating its suppressive effects on T lymphocytes， preserving NK cell activity， and reducing elevated levels of HIF-1α. Consequently， this approach exerts minimal impact on the tumor immune microenvironment （TIME） in patients.

Key words: nociceptive level index, radical mastectomy, cellular immunity, remifentanil, hypoxia-inducible factor-1α

CLC Number:

R614.2

Yinzhou ZHAN,Junheng CHEN,Chao CHEN,Chuyuan CAI,Xuezhu MA,Chunming. GUO. Nociceptive level index guides the effect of remifentanil infusion target concentration on cellular immunity and HIF-1α in patients undergoing radical mastectomy[J]. The Journal of Practical Medicine, 2024, 40(18): 2566-2570.

Figures/Tables 4

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References 31

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项目	对照组	观察组	t/Z/χ ² 值	P 值
年龄（x ± s）/岁	54.93 ± 12.57	53.15 ± 9.87	0.702	0.485
BMI（x ± s）/（kg/m²）	20.75 ± 1.71	20.99 ± 1.96	-0.583	0.561
麻醉时间（x ± s）/h	2.79 ± 0.46	2.80 ± 0.30	-0.1	0.92
手术时间/h	2.20（1.92，2.30）	2.27（2.17，2.35）	1.581	0.114
ASA分级/［例（%）］			0.75	0.785
Ⅰ级	9（22.5）	8（20.0）
Ⅱ级	31（77.5）	32（80.0）
MAP/mmHg
麻醉前	82.5（75.3，87.5）	83.5（75.5，83.5）	-0.058	0.954
切皮时	84.0（75.0，87.5）	83.0（75.5，85.8）	-0.14	0.889
剥离乳腺组织	84.0（75.0，88.0）	83.5（78.0，87.0）	-0.28	0.780
缝皮时	84.0（75.0，88.8）	84.0（75.0，88.0）	-0.496	0.620
HR/（次/min）
麻醉前	68.5（64.0，75.8）	68.0（63.0，78.8）	-0.034	0.973
切皮时	71.0（63.3，78.0）	72.0（63.0，75.0）	0.202	0.840
剥离乳腺组织	74.0（60.3，78.0）	72.0（60.0，79.5）	-0.039	0.969
缝皮时	71.0（66.5，77.0）	71.5（61.3，78.0）	0.222	0.824
VAS评分/［例（%）］
术后4 h	3（2，4）	3（2，4）	-0.005	0.996
术后12 h	3（2，3）	3（2，3）	0.137	0.891
术后24 h	3（2，3）	3（2，3）	0.058	0.954

项目	对照组	观察组	Z值	P值
丙泊酚浓度/（μg/mL）	3.9（3.8,4.1）	3.9（3.8,4.1）	0.565	0.572
瑞芬太尼浓度/（ng/mL）	5.1（5.0,5.2）	4.1（4.0,4.1）	-7.638	< 0.001

项目	对照组	观察组	Z值	P值
CD4⁺
术前	36.0（30.5，40.0）	35.0（33.0，38.0）	-0.217	0.828
术后	22.5（18.0，26.0）	29.0（21.3，33.0）	3.797	0.000
Z值	-6.532	-5.42
P值	< 0.001	< 0.001
CD8⁺
术前	21.5（19.3，23.0）	22.0（20.0，24.0）	0.853	0.394
术后	18.0（16.0，23.0）	21.5（19.3，23.0）	1.521	0.128
Z值	-2.768	-1.109
P值	0.006	0.268
CD4⁺/CD8⁺
术前	1.63（1.39，1.86）	1.59（1.46，1.75）	0.303	0.762
术后	1.13（1.01，1.26）	1.32（1.05，1.66）	2.161	0.031
Z值	-5.491	-3.653
P值	< 0.001	< 0.001
NK细胞
术前	26.0（22.3，30.0）	2.07（24.3，30.0）	1.283	0.199
术后	23.0（20.3，25.0）	25.5（20.0，33.8）	1.962	0.005
Z值	-2.771	-0.593
P值	0.006	0.553

项目	对照组	观察组	Z值	P值
术前	117.5（112.0，129.8）	120（113.3，123.0）	0.371	0.711
术后	143.2 ± 7.28	127.4 ± 14.3	6.224	0.000
Z值	6.537	2.282
P值	< 0.001	0.022

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Nociceptive level index guides the effect of remifentanil infusion target concentration on cellular immunity and HIF-1α in patients undergoing radical mastectomy

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