摘要
目的探讨不同麻醉方法对肺癌根治术患者围术期T细胞亚群及细胞因子的影响。方法择期肺癌根治术患者30例,随机分为2组:静脉丙泊酚复合硬膜外麻醉组(A组)和全凭静脉麻醉组(B组),每组15例。2组患者入室前30 min肌肉注射阿托品0.5 mg及咪达唑仑0.05 mg/kg,麻醉诱导方法相同。A组术中靶控输注丙泊酚维持镇静,硬膜外间断推注0.375%罗哌卡因维持镇痛;B组术中靶控输注丙泊酚维持镇静,靶控输注瑞芬太尼维持镇痛;2组均采用曲马多术后镇痛。分别于麻醉前(T_0)、手术开始后1 h(T_1)、术毕(T_2)、术后1 d(T_3)、术后3d(T_4)抽取外周静脉血5 ml,1 ml采用流式细胞分析技术(FCM)检测T细胞亚群,4 ml离心取血清采用ELISA法测定血清白介素-2(IL-2)及干扰素-γ(INF-γ)的浓度。结果2组CD_3^+、CD_4^+均于T_1开始下降,A组于T_3降至最低(P<0.01),B组于T_2降至最低(P<0.01)。T_4 2组有所恢复,但仍低于T_0(P<0.05)。与A组比较,B组T_1、T_2差异有统计学意义(P<0.05)。2组CD_8^+各时点差异无统计学意义,CD_4^+/CD_8^+ A组于T_2、T_3下降,B组于T_1、T_2、T_3下降(P<0.05,P<0.01)。2组血清IL-2浓度变化,与T_0比较,B组T_2、T_3、T_4差异有统计学意义,A组T_3、T_4差异有统计学意义(P<0.05)。与A组比较,B组T_2时差异有统计学意义(P<0.05)。2组INF-γ浓度T_2、T_3降低,与T_0比较差异有统计学意义(P<0.05,P<0.01);与A组比较,B组T_2时下降明显,差异有统计学意义(P<0.05)。结论静脉丙泊酚复合硬膜外麻醉对肺癌根治术患者T细胞亚群及IL-2、INF-γ浓度的影响较小,利于维持机体免疫平衡。
Objective To investigate the effects of different anesthesia method on T lymphocyte subsets and cytokines in lung cancer with radical operation. Methods Thirty patients with lung cancer underwent radical operation were randomly divided into two groups with 15 cases in each group respectively. The patients were given midazo- lam 0.05 mg/kg and atropine 0.5mg/kg intramuscularly 30 minutes before operation, and the methods of anesthesia induction were similar in both two groups. In A group, 0.375% ropivacaine was given intermittently, and TCI propofol to keep BIS. In B group, propofol （target level 4 -6mg/ml ） and remifentanil （target level 4 -6ng/ml） were used to maintain anesthesia condition. The venous blood was drown from each patient at the following times points： before anesthesia（T0 ）, lh after the beginning of operation（ T1 ） , immediately after operation（ T2 ）, ld（ T3 ） and 3d （ T4 ） after operation, another 1 ml venous blood for analysis of the expression of T lymphocyte subsets by flow cytome try （FCM） , 4ml venous blood for measurement of the serum concentrations of IL-2 ,and INF-γ by ELISA. Results The expression of CD3＋ and CD4＋ were decreased at the time point T1 in both two groups, and the lowest time point was T3 in A group,while T2 in B group （ P 〈0.01 ）. At the time point T4 ,the indexes became recovepy, while lower than To （ P 〈 0.05 ）. There was statistical difference between A group and B group in expression of CD3＋ and CD4＋ at time point T1 and T2 （ P 〈 0.05 ）. No difference could be found in expression of CD8＋ As for CD4＋/CD8＋ ,the value was decreased at time point T2 and T3 in A group,while at T1 ,T2 and T3 in B group （ P 〈0.01 orP 〈0.05）. As for the level of IL-2 ,there was statistical difference at time point T2 ,T3 and T4 in B group,while at Ts and T4 in A group （ P 〈0.05）. The concentration of INF-γ was decreased at the time point T2 and T3 ,compared with To（ P 〈0.01 or P 〈 0.05 ）, while B group was
出处
《疑难病杂志》
CAS
2010年第3期171-173,共3页
Chinese Journal of Difficult and Complicated Cases
基金
河北省普通高等学校强势特色学科肿瘤学建设经费资助项目(No.2005-52)
关键词
肺癌根治术
麻醉
全身
硬膜外
免疫细胞
Lung cancer with radical operation
Anesthesia,general,epidural
Immunocyte
