The Effect Of Intravenous Anesthetic On Peripheral Blood Lymphocyte Subsets In Healthy Volunteers And Cancer Patients:a Controlled Study

Objective: The purpose of this study was to investigate the effect of intravenous anesthetic on peripheral blood lymphocyte subsets in healthy people and cancer patients.Methods: According to the approval of the Dalian Hospital Ethics Committee,we recruit and select 20 healthy volunteers(healthy group)aged 20-50 years old during in May 2018 to October 2018.ASA grade was I.20 patients who underwent breast cancer surgery were enrolled in this study(cancer group).30-60 years old,ASA grade I-II,tumor TNM classification 0-II level.All the people in this study signed the informed consent,entered the operation room for general vital monitoring,and opened two peripheral venous pathways.We use target controlled infusion of propofol anesthesia in healthy group.The depth of anesthesia was adjusted to maintain a Bispectral Index Score(BIS)of 40–60.Non-invasive blood pressure,blood oxygen saturation and ECG monitoring were used.The number of peripheral blood lymphocyte subsets were measured before anesthesia and when the BIS approximately reached 50,and 30 min,1h,2h after induction.And also the time point of the volunteer woke up,and 2h,24 h,48h,72 h after woke up.2ml peripheral blood was extracted at 10 time point.The T1-T3 time point operation in the cancer group was the same as that in the healthy group.After propfol infusion for 30 min,cis-atacuronium 0.2mg/kg and remifentanil 4ug/kg were administered.The laryngeal mask was inserted to establish an artificial airway,and the anesthesia machine was connected for mechanical ventilation.During the operation,target controlled infusion of propofol and continuous infusion of remifentanil were maintained,and cis-atracurium was intermittently supplemented.During the operation,the pumping rate of propofol and remifentanil was adjusted according to the depth of sedation,surgical progress and patients' hemodynamic changes,and vasoactive drugs were applied to maintain hemodynamic stability(norepinephrine,dopamine,atropine,etc.)if necessary.Surgery at the end of the peripheral blood of T5,24 h after surgery is peripheral blood of T6.Peripheral blood samples were all time points in EDTA tube blending into 4 ? refrigerator after staging,lymphocyte subsets was analyzed by flow cytometry(FCM)at different time points.The main projects included total T lymphocyte,CD8+ lymphocyte,CD4+ lymphocyte,NK cell,and CD4+/CD8+ ratio.Results: 20 people's peripheral blood samples were qualified and into the experimental results.In the cancer group,20 patients were included.General data(age,preoperative hemoglobin,albumin,liver and kidney function,tumor site,degree of differentiation,TNM stage,etc.)showed no statistical significance(P>0.05).Changes in the number of peripheral blood lymphocyte subsets: The total number of lymphocytes,T lymphocytes,CD4+ lymphocytes,CD8+ lymphocytes and NK cells in the healthy group were statistically different from that before the target-controlled infusion of propofol at 30 min,1h,2h and the time of awakening(P<0.05),and the CD4+/CD8+ ratio was not significantly different at each time point.The t1-t3 time point of the tumor group was the same as that of the healthy group,P>0.05,and the difference was not statistically significant.After the administration of opioids,muscle relaxants,laryngeal mask airway establishment,and surgical stimulation,it was observed that the airway was still not restored to the preoperative level for 24 h after the operation.Compared with the healthy group,all the patients had recovered and were higher than the preoperation level,and 3 days later the highest value was reached after the anesthesia(P<0.05),the difference was statistically significant.Conclusion: Medium-chain propofol can significantly inhibit the immune function of human body.It affects the immune function through the transient inhibition of rapid recovery,and it can gradually recover to the pre-administration level 2 hours after withdrawal.The effect of propofol on the immune function of breast cancer patients undergoing elective surgery was not significantly different from that of healthy people.The slow recovery of the number of lymphocyte subsets in breast cancer patients after surgery may be related to other anesthetic drugs and surgical stimulation.