不同麻醉和镇痛方法对食管癌手术患者细胞免疫功能及应激激素水平的影响

目的观察不同麻醉和镇痛方法下食管癌手术患者术中和术后外周静脉血T淋巴细胞亚群和相关细胞因子及应激激素水平的变化。方法选择60例择期食管癌手术病人,随机分为两组:A组采用全凭静脉麻醉,术后行患者自控静脉镇痛;B组采用胸段硬膜外阻滞复合静脉全麻,术后行患者自控硬膜外镇痛,每组30例。分别于麻醉前(T0)、切皮后2h(T1)、术后4h(T2)、术后24h(T3)、术后48h(T4)抽取两组患者静脉血,流式细胞术测定CD4+%和CD8+%,计算CD4+/CD8+比值,ELISA法测定各时间点血清白介素-2(IL-2)和可溶性白介素-2受体(sIL-2R);并用放射免疫法测定各时段的血清应激激素生长激素(GH)、催乳素(PRL)、白介素-8(IL-8)及皮质醇(Cor)的含量。结果(1)B组T2、T3时点的VAS评分均明显低于A组(P<0.05)。(2)除CD8+%外,两组CD4+%、CD4+/CD8+比值从T1开始下降(P<0.05),T2时B组降至最低(P<0.01),T3时A组降至最低(P<0.05);T1至T4时点B组CD4+%明显高于A组(P<0.05),T3至T4时点B组CD4+/CD8+比值明显高于A组(...

Effects of different anesthetic and analgesic protocols on cellular immune function and stress hormone level in patients undergoing lobectomy for esophagus cancer

Objective To investigate the effects of different anesthetic and analgesic protocols on the cellular immune function and stress hormone in patients undergoing lobectomy for esophagus cancer. Methods Sixty ASA I or II patients undergoing lobectomy for esophagus cancer were randomly divided into two groups to receive postoperative general anesthesia and intravenous analgesia (group A, n=30) or intraoperative general anesthesia combined with thoracic epidural anesthesia with postoperative epidural analgesia (group B, n=30). The cervical venous blood samples were obtained from the patients at 30 rain before anesthesia induction (T_0), 2 h after skin incision (T_1), and at 4 h (T_2), 24 h (T_3) and 48 h (T_4) after the end of operation. The T-lymphocyte subsets (CD4~+ and CD8~+) were analyzed by flow cytometry, serum concentrations of slL-2R and IL-2 determined by ELISA, and the levels of growth hormone (GR), prolactin (PRL), IL-8 and cortisol (Cur) measured by radioimmunoassay. Visual analogue scale (VAS) was used for assessment of the postoperative analgesic effects. Results The VAS scores were significantly lower in group B than in group A at T_2 and.T_3 (P<0.05). The percentage of CD4~+ cells and the CD4~+/CD8~+ ratio in the two groups began to decrease significantly at T_1 (P<0.05), reducing to the lowest level at T_2 in group B and at T_3 in group A. From T_1 to T_4, the percentage of CD4~+ in group B remained significantly higher than those in group A (P<0.05), and from T_3 to T_4, the CD4~+/CD8~+ ratio in group B were significantly higher than those in group A (P<0.05). The IL-2 level in the two groups began to decrease significantly at T_1 (P<0.05), reaching the lowest level at T_2 in group A and at T_3 in group A. IL-2 level was significantly higher in group B than in group A from T_3 to T_4 (P<0.05). sIL-2R level in group A began to increase at T_1 and peaked at T_3, showing significant differences from the T0 level, but the level showed no significant variations in group B compared with the T0 level. From T_2 to T_4, sIL-2R level was significantly higher in group A than in group B (P<0.05). The levels of GH, PRL and Cur increased significantly, while IL-8 decreased in the two groups from T_1 to T_4 (P<0.05), but remained stable in group B. Conclusion General anesthesia combined with thoracic epidural anesthesia may reduce the perioperative stress reaction and adverse effect on cellular immune function in patients undergoing lobectomy for esophagus cancer.