Effect Of Desflurane On Perioperative Cellular Immune Function In Patients Undergoing Modified Radical Mastectomy For Breast Cancer

Objective:To investigate the effect of desflurane on perioperative cellular immune function in patients undergoing modified radical mastectomy for breast cancer.Methods:Sixty patients,aged 30-65 years,with a body mass index of 18-25 kg/m²,ASA grade I-II and TNM stage I-II,who were prepared for modified radical mastectomy of breast cancer were selected.Using random number table method,60 patients were divided into two groups.Both groups received the same anesthesia induction method:intravenous injection of propofol 1～2mg·kg^-1,sufentanil citrate 0.4mg·kg^-1,cisatracurium 0.2mg·kg^-1.Anesthesia maintenance:the experimental group sustained inhalation of desflurane and maintained MAC 0.8～1.3 during the operation;the control group was given propofol 4～6mg·kg^-1·h^-1by intravenous pump.And both groups received constant intravenous infusion of remifentanil 0.1～0.2ug·kg^-1·min^-1and cisatracurium 0.07～0.1mg·kg^-1·h^-1.The BIS value was maintained at 40 to 60during anesthesia.Both groups were operated on by the same surgeon.HR,SBP,DBP,Sp O2 and BIS were recorded at the time of entering the operating room,at the end of the operation and at the time of extubation.Anesthesia time,operative time,intraoperative fluid infusion volume,blood loss and urine volume were also recorded.Peripheral venous blood samples were collected 30 minutes before anesthesia induction（T0）,at the end of operation（T1）,24 hours after operation（T2）and 72hours after operation（T3）,respectively.Then flow cytometry was used to detect the CD3⁺,CD4⁺,CD8⁺,CD4⁺/CD8⁺ratio of T lymphocyte subsets and the level of NK cells.Results:1、Basic information of patients:there was no statistical significance in age,BMI,ASA grade,TNM stage,intraoperative amount of remifentanil,anesthesia time,operation time,intraoperative fluid infusion volume,blood loss and urine volume between the two groups（P>0.05）.2、Comparison of patients’intraoperative vital signs:there was no statistical significance in HR,SBP,DBP,Sp O2 and BIS values between the two groups at the time of entering the operating room,skin incision,at the end of the operation and at the time of extubation（P>0.05）.3、Comparison of cellular immune function indexes at each time point in perioperative period:there was no statistical significance in the percentage of T lymphocyte subsets and NK cells in peripheral blood between the two groups 30min before induction.Compared with T0,the percentages of CD3⁺and CD4⁺and the ratio of CD4⁺/CD8⁺in both groups were significantly decreased at T1（P<0.05）,and there was no statistical significance between the two groups.At T2,the contents of CD3⁺and CD4⁺and the ratio of CD4⁺/CD8⁺in both groups returned to the preoperative level.Compared with T0,the percentage of NK cells at T1 was significantly decreased in both groups（P<0.05）.Compared with the experimental group,the percentage of NK cells in the control group decreased significantly at T1（P<0.05）.The percentage of NK cells in both groups was still lower at T2 than before（P<0.05）.Compared with the experimental group,the percentage of NK cells in the control group decreased significantly at T2（P<0.05）.At T3,the percentage of NK cells in both groups returned to the preoperative level.Conclusion:The patients undergoing modified radical mastectomy after desflurane anesthesia had transient cellular immunosuppression during the perioperative period,but the rate of NK cell decline was lower than that of propofol anesthesia,therefore desflurane anesthesia has less adverse effects on the immune system in modified radical mastectomy of breast cancer than propofol anesthesia,and desflurane anesthesia is suitable for patients with low NK cells.