摘要
目的 探讨两种不同麻醉方案对乳腺癌根治术病人围术期T淋巴细胞亚群及自然杀伤细胞 (NK细胞 )的影响。方法 选择乳腺癌根治术病人 32例 ,随机分为两组。Ⅰ组为单纯全麻 ,Ⅱ组为全麻复合硬膜外麻醉。分别于麻醉前、麻醉后 2h、术后 1d和 7d抽取静脉血 ,用流式细胞仪测定T细胞亚群和NK细胞的数量。结果 两组麻醉后 2hCD3+ 、CD4+ 、CD4+ /CD8+ 、NK细胞均有所下降 ,与麻醉前相比 ,Ⅰ组P <0 0 5 ;术后 1d下降较为显著 ,与麻醉前相比 ,Ⅰ组P <0 0 1,Ⅱ组P <0 0 5 ,组间比较亦有显著性差异 (P <0 0 5 ) ;术后 7d各组数据已恢复至术前水平。结论 乳腺癌根治术病人麻醉、手术后细胞免疫功能有一过性的不同程度的抑制 ,其中以单纯全麻组更为明显 ,全麻复合硬膜外麻醉组明显轻于单纯全麻组。
Objective To evaluate the effects of different anesthesia methods on postoperative change in T lymphocyte subsets and NK cells in patients undergoing radical mammotomy. Methods Thirty-two patients with breast cancer were randomly assigned into one of the two groups with 16 patients each.GroupⅠreceived general anesthesia only,and group Ⅱ general anesthesia plus epidural blockade. The patients were premedicated with sodium phenobarbital 0.1g and atropine 0.5mg. Anesthesia was induced with fentanyl 2μg/kg,midazolam 0.1mg/kg, propofol 1.5mg/kg, succinylcholine 1.5mg/kg, and maintained by 0.5%-1.5% isoflurane inhalation, and intravenously pumping fentanyl 0.02μg·kg -1·min -1 and vecuronium 1μg·kg -1·min -1. Epidural anesthesia was administered at T 3-4 or T 2-3 with 1% lidocaine and 0.1% tetracaine in group Ⅱ. Peripheral venous blood samples were taken before anesthesia, at 2h after anesthesia, and on the1 st and 7 th postoperative day for determination of subsets of T-lymphocyte CD3 +,CD4 +,CD8 +,CD4 +/CD8 + and NK cells by flow cytometer. Results The CD3 +,CD4 +,CD4 +/CD8 + and NK cells decreased at 2h after anesthesia in the two groups compared with those before anesthesia. However, Significant differences were found only in groupⅠ(P<0.05). The values further decreased in groupⅠ(P<0.01) and in groupⅡ(P<0.05) on the 1st postoperative day, and there were also significant differences between the two groups at the same time.On the 7th postoperative day, the CD3 +,CD4 +,CD4 +/CD8 + and NK cells returned to the preoperative levels in both groups.Conclusion The two different anesthesia methods have transient inhibitory effects on cellular immune function in patients undergoing radical mammotomy intra-and-postoperation , which is less in combined general anesthesia with epidural block.
出处
《临床麻醉学杂志》
CAS
CSCD
2003年第6期332-334,共3页
Journal of Clinical Anesthesiology
关键词
麻醉
乳腺癌
根治术
围术期
T淋巴细胞亚群
NK细胞
影响
Combined general anesthesia
Epidural block
Immunity
T-lymphocytes subsets
Killer cells
