摘要
目的研究比较全身麻醉和硬膜外麻醉联合全身麻醉两种麻醉方式对腹腔镜结肠癌患者围手术期的细胞免疫和IL-6的影响。方法选择2013年1月-2014年12月期间在我院进行腹腔镜结肠癌根治手术的患者40例,随机分成研究组和对照组,每组20例,研究组患者手术的麻醉方式为硬膜外麻醉联合全身麻醉,对照组患者的手术麻醉方式为与研究组相同的全身麻醉方式。在以下时间点对患者取静脉血,分别是麻醉前半小时(t1)、手术开始后2 h(t2)、手术结束时(t3)、手术结束后第1天(t4)、手术结束后第3天(t5),用流式细胞仪测定T淋巴细胞各亚群和NK细胞的比例,比较两组患者T淋巴细胞亚群和NK细胞的活性百分比,并且用ELISA法测定IL-6后比较两组的含量变化。结果单独比较组内的变化可知,从t2时刻开始,患者的CD3+、CD4+和CD4+/CD8+含量开始下降,对照组t1时间点与t3~t5时间段的差异有统计学意义(P〈0.05),研究组与对照组比较,t2~t5时间段内的CD3+、CD4+和CD4+/CD8+含量研究组明显高于对照组,差异有统计学意义(P〈0.05),两组患者组间和组内的CD8+含量差异没有统计学意义(P〉0.05)。两组患者的NK细胞含量无明显变化,IL-6在t2~t5时间段内均明显升高(P〈0.05),t2~t4时间段内对照组IL-6水平明显高于研究组,差异有统计学意义(P〈0.05)。结论患者的细胞免疫功能在腹腔镜结肠癌中受到了一定的抑制,使用硬膜外麻醉联合全身麻醉对患者细胞免疫功能和IL-6水平造成的影响相比仅使用全身麻醉的方式而言小,建议临床中腹腔镜结肠癌患者的手术方式使用硬膜外麻醉联合全身麻醉。
【Objective】To study the effects of conventional general anesthesia or Epidural anesthesia compound protocols on perioperative contents of T-lymphocyte subsets, natural killer cell(NK cells) and IL-6 in patients undergoing laparoscopic surgery for colorectal cancer. Discussing anesthesia methods contribute less to cellular immunity. 【Methods】40 patients undergoing laparoscopic surgery for colorectal cancer in our hospital during January 2013 to December 2014,they were randomly divided into two groups. Thecontrol group was dealt with conventional general anesthesia and the study group was Epidural anesthesia compound conventional general anesthesia. Venous blood samples were taken at the before anesthesia(t1),2 h after skin incision(t2),at the end of operation(t3), 1 day after operation(t4) and 3 days after operation(t5). T-lymphocyte value and natural killer cell were determined by flow cytometry instrument. IL-6 was determined by enzyme-linked immunoassay. Compared two groups of immune indexes. 【Results】From t2 on, the levels of CD3+、CD4+、CD4+/CD8+were all decreased, and those indicators were significantly decreased at t1 compared with t3-t5(P0.05).The levels of CD3+、CD4+、CD4+/CD8+ in study group is higher than the control group. There were no significant differences in the levels of CD8+ at any times between two groups or compared with t1. There were no significant differences in the levels of NK cells at any times between two groups or compared with t1. The level of IL-6 was significantly decreased at t2~t5 in two groups. And the study group was significantly higher than the control group at t2~t4. 【Conclusion】There were inhibition of perioperative cellular immune function in patients undergoing laparoscopic surgery for colorectal cancer in both of groups. However, Epidural anesthesia compound has less inhibitory effect on perioperative cellular immune function and IL-6 than conventional general anesthesia in patients undergoing laparoscopic
出处
《中国医学工程》
2015年第6期10-11,15,共3页
China Medical Engineering