Comparision Of The Effect Of Etomidate And Propofol Target-Controlled Infusion On Perioperative Lymphocyte Subsets In Breast Cancer Patients

Objective:To observe the changes of lymphocyte subsets in breast cancer patients after intravenous anesthesia with etomidate and propofol,so as to evaluate the effects of two drugs on the immune function of breast cancer patients during perioperative period.Method:1.Selection of experimental subjects:60 female patients from Second Affiliated Hospital of Da Lian Medical University from March 2018 to January 2019who were planning to undergo breast surgery were selected.All the patients who participated in the study signed the informed consent form.They were classified as Grade I to II by the ASA,aged 25 to 60,BMI<28kg/m2,no serious hypertension,diabetes and other basic diseases.Seven patients refused to participate in the experiment,three patients did not meet the inclusion criteria,and the remaining 50 subjects were randomly grouped,25 in each group.2.Experimental methods:?1?After entering the operating room,patients were monitored for heart rate,blood pressure,oxygen saturation and BIS,and peripheral venous access was established for infusion.Radial artery catheterization was performed to observe the changes of ambulatory blood pressure and blood sample collection.After the patient was calm,2ml of peripheral blood was taken at T1?after entering the room?to record the vital signs immediately after the blood was drawn.?2?Anesthesia induction:After sample collection at T1,E?etomidate?group received target-controlled infusion of 0.5 ug/ml plasma concentration of etomidate,which was adjusted to 0.3-0.5 ug/ml after BIS was reduced to 50 and stabilized;P?propofol?group received target-controlled infusion of 4 ug/ml plasma concentration,which was adjusted to 2.5-3.5 ug/ml after patients'consciousness disappeared;oxygen flow rate was 6 L/m after mask inhalation.After 30 minutes of sedative infusion,remifentanil 2-4 ug/kg+cis-atracurium 0.15-0.25 mg/kg was given for anesthesia induction.?3?Maintenance of anesthesia:Target-controlled concentration of etomidate and propofol and pump speed of remifentanil were adjusted according to BIS value,so that BIS was maintained at about 50 and muscle relaxant was supplemented intermittently.Remifentanil infusion was stopped 5 minutes before operation,and sedative infusion was stopped immediately after operation?T5?blood samples were collected.?3?Anesthesia maintenance:The target concentration of etomidate and propofol and the pump speed of remifentanil were adjusted according to the BIS value,so that BIS was maintained at about 50 and muscle relaxant was supplemented intermittently.Remifentanil infusion was stopped 5 minutes before operation,and sedative infusion was stopped immediately after operation?T5?blood samples were collected.3.Sample collection:After entering the room?T1?,BIS stabilized at about 50?T2?,15 minutes?T3?,30 minutes?T4?,immediately after operation?T5?,24 hours?T6?,peripheral blood samples were collected at the above time points,placed in vacuum test tube containing EDTA K2 anticoagulant,and sent to the laboratory for determination by flow cytometry.Total lymphocyte count,total T lymphocyte count,CD4⁺lymphocyte count,CD8⁺lymphocyte count,NK cell count,CD4⁺/CD8⁺ratio.At the same time,the vital signs of the above six time points were recorded.Result:1.Basic vital signs:There was no significant difference in BIS value between the two groups at the time points of T2-T5?P>0.05?,but it could be maintained between 40 and 60.At the same time point,there was no significant difference in BIS value between the two groups?P>0.05?.Blood oxygen saturation?SPO₂?:There was no significant difference between groups at different time points?P>0.05?,but there was no significant difference between groups at the same time point?P>0.05?.The dosage of vasoactive drugs in group E was significantly lower than that in group P?P<0.05?.2.Adverse events:The incidence of hypotension and injection pain in group P was significantly higher than that in group E?P<0.05?,and there was no significant difference in the incidence of residual nausea,vomiting and muscle tremor between the two groups?P>0.05?.3.Lymphocyte subsets count:The total number of CD3⁺,CD4⁺,CD8⁺,NK cells in both groups decreased significantly at T2?P<0.05?,and decreased with time,and decreased to the lowest level at T4?P<0.05?.T5 began to show an upward trend,but it was still significantly lower than that of T1?P<0.05?.T6time points were all restored to that of T1?P>0.05?.The ratio of CD4⁺/CD8⁺in group E was higher than that of T1-T.4 showed an upward trend?P<0.05?,T5 began to decline,T6 returned to the initial level,CD4⁺/CD8⁺ratio in group P showed an upward trend in T1-T3?P<0.05?,T4 began to decline,T6 restored to the initial level?P>0.05?;inter-group comparison,CD3⁺cell count level in group E at T4 and T5 time points was significantly higher than that in group P?P<0.05?,CD4⁺cell,NK cell level and CD4⁺/CD8⁺ratio at T4 time points were all higher than those in group P?P<0.05?.The number of lymphocyte subsets in group P was significantly higher than that in group P?P<0.05?.There was no significant difference in the number of lymphocyte subsets between groups at other time points?P>0.05?.Conclusion:Target-controlled infusion of etomidate and propofol can decrease the number of lymphocyte subsets in patients undergoing breast cancer surgery,but it will return to the initial level 24 hours after operation.The effect of etomidate target-controlled infusion on lymphocyte subsets is lower than that of propofol.