不同麻醉方法对胃癌患者围术期T淋巴细胞亚群的影响

目的 探讨不同麻醉方法对胃癌患者围术期T淋巴细胞亚群的影响。方法 36例择期胃癌根治术患者，随机分为硬膜外阻滞组（I组）、全麻组（Ⅱ组）和硬膜外阻滞复合全麻组（Ⅲ组），每组12例，分别于诱导前、术毕及术后1、3、5、7d取外周静脉血2ml，采用APAAP法测定T淋巴细胞亚群的变化。结果 与诱导前相比，术毕、术后第1、3d各组CD3^ 、CD4^ 、CD8^ 、及CD4^ /CD8^ 均明显下降（P＜0．05）；术后第5d，Ⅲ组各指标恢复（P＞0．05）；术后第7d，Ⅰ、Ⅱ组各指标恢复（P＞0．05）。Ⅲ组CD3^ 、CD4^ 及CD4^ /CD8^于术后第5d明显高于Ⅰ、Ⅱ组（P＜0．05）。结论 硬膜外复合全麻能减轻围术期应激反应及麻醉药物对T淋巴细胞亚群的抑制，有利于胸腹部肿瘤病人免疫功能的及早恢复。

Effects of different anesthetic techniques on perioperative changes in T-lymphocyte subsets in patients with gastric cancer

Objective To determine the effects of different anesthetic techniques on T-lymphocyte subsets in patients undergoing radical gastric cancer operation, trying to find an anesthetic technique causing least immunodepression for this type of surgery. Methods Thirty-six ASA Ⅰ -Ⅱ patients undergoing elective radical operation for gastric cancer, age between 40-60 years and body weight 50-80 kg, the patients were randomly assigned to one of three groups, group Ⅰ: epidural anesthesia; group Ⅱ: general anesthesia; group Ⅲ: epidural anesthesia combined with general anesthesia( n ＝ 12 in each group). The patients were premedicated with intramuscular luminal sodium 0.1 g and atropine 0.5 mg. In group Ⅰpatients received an epidural catheter at T7-8 or T8-9 and block was carried out by 1.5% lidocaine mixed with 0.25% pontocaine (6:2 solution). The loading dose was 10-15 ml. During the operation the patients were sedated with pethidine , fentanyl or diazepam. In group Ⅱ general anesthesia was induced with fentanyl 0.1-0.2mg, droperidol 2.5-5.0 mg and etomidate 0.2-0.3mg/kg. Intubation was facilitated with succinylcholine 100 mg. Anesthesia was maintained with continuous infusion of propofol and inhalation of enflurane. Peripheral blood samples were taken before induction, at the end of operation and on 1st, 3rd,5th and 7th postoperative day for detrmination of CD3+, CD4+, CD8+ and CD4+/CD8+ values by APAAP method. Results There were no significant differences in age, body weight, ASA class, and surgical duration between the 3 groups. CD3+, CD4+, CD8+ and CD4+/CD8+ decreased significantly at the end of operation and on the 1st and 3rd postoperative day in all groups (P<0.05) . In group Ⅲ CD3+ , CD4+ ,CD8+ and CD4+/CD8+ almost returned to baseline values on the 5th postoperative day . In group Ⅰ and ⅡCD3+ , CD4+ , CD8+ and CD4+/CD8+ were close to baseline values on the 7th postoperative day .On the 5th postoperative day CD3+, CD4+ and CD4+/CD8+ were significantly higher in group Ⅲ than those in group Ⅰand Ⅱ (P<0.05).Conclusions Epidural anesthesia combined with general anesthesia can reduce depression of T-lymphocyte subsets induced by surgical trauma and anesthesia, and is the anesthetic tecnique of choice for cancer patients undergoing major operation.