术后硬膜外镇痛对机体免疫功能的影响

目的　测定围术期外周血T淋巴细胞亚群的变化 ,旨在探讨术中及术后连续硬膜外镇痛对免疫功能的影响。方法　 3 2例病人随机分为 4组 ,每组 8例。Ⅰ组在全麻下、Ⅱ组在全麻复合硬膜外麻醉下行上腹部胃癌根治术 ,Ⅲ组在全麻下、Ⅳ组在全麻复合硬膜外麻醉下行下腹部全子宫切除术 ,Ⅱ、Ⅳ组术后连续硬膜外镇痛 4 8h。分别于手术日晨 ,手术切皮后 1h ,术后第 1、3、7d晨抽取患者肘部静脉血 ,测定T淋巴细胞亚群CD3+(总T淋巴细胞 )、CD4+(辅助性 /诱导性T淋巴细胞 )和CD8+(抑制性 /杀伤性T淋巴细胞 )及C 反应蛋白 (CRP)浓度。结果　Ⅰ组术后第 1d、第 3dCD4+、CD8+比术前显著下降(P <0 .0 1) ;Ⅱ组、Ⅲ组各时间点T淋巴细胞亚群无显著改变 (P >0 .0 5 ) ;Ⅳ组术后第 1dCD4+表达受抑 (P <0 .0 1)。上腹部手术 (Ⅰ、Ⅱ组 )较下腹部手术 (Ⅲ、Ⅳ组 )CRP显著升高 (P <0 .0 5 )。结论　上腹部手术应激反应明显 ,术中、术后硬膜外镇痛可减轻应激反应 ,有利于细胞免疫功能的稳定 ;下腹部手术应激反应轻 ,细胞免疫功能无显著改变 ,术后硬膜外镇痛无助于机体免疫功能的维护。

Influences of epidural analgesia of post-operation on the immune functions of T lymphocyte subsets in peripheral blood

Objective To investigate the influences of continuous epidural analgesia on immune function,authors observed the changes of peripheral blood T lymphocyte subsets during perioperative period.Methods Thirty-two patients were randomly allocated to 4 groups (8 cases in each group),which 16 gastric cancer patients underwent gastrectomy under general anesthesia(group I)and general combined epidural anesthesia (group II),and the other 16 cases of hysterectomy were performed under general anesthesia(group Ⅲ)and general combined epidural anesthesia(group Ⅳ).In group Ⅱ and Ⅳ,successive epidural analgesia were used for 48h,first hour after skin incision,and 1,3,7d after operation T lymphocyte subsets(CD 3 +,CD 4 +,CD 8 +)and C-reactive protein(CRP)concentration were measured.Results Compared with those before operation,CD 4 + and CD 8 + decreased significantly on the lst d and 3rd d after operation in group Ⅰ(P<0.01),had no difference in group Ⅱ and Ⅲ(P<0.05) ,and CD + 4decreased on the lst(P<0.01)and 3rd d(P< 0.05 ) after operation in group Ⅳ.CRP concentration was much higher in group Ⅰ and Ⅱ than those in group Ⅲ and Ⅳ(P<0.05).Conclusion Upper abdominal operation has stronger stress response,and continuous epidural analgesia might diminish the stress responses,therefore,is favorable for the stabilization of cellular immune function;lower abdominal operation has less stress response,and has no significant change in immune function,but post operative analgesia might also affect the express of lymphocyte immune function.