胃癌根治术中不同麻醉方法对患者血清sIL-2R及T细胞亚群的影响

目的探讨不同麻醉方法是对胃癌根治术患者围手术期外周血可溶性白细胞介素-2受体(sIL-2R)和T淋巴细胞亚群的影响.方法 36例择期行胃癌根治术患者随机分为硬膜外阻滞组(A组)、静吸复合全麻醉组(B组)、硬膜外阻滞加全麻组(C组);于麻醉前、切皮前、切皮后2h及术后第1,3,5天分别检测外周血sIL-2R和T淋巴细胞亚群.结果切皮前三组sIL-2R和T淋巴细胞亚群较麻醉前没有明显变化;切皮后2h、术后1d和3d,A、B组sIL-2R明显升高(P＜0.01),且在施术2h、术后1d血清sIL-2R高于C组,C组术后1d增高(P＜0.01).三组病人血T淋巴细胞亚群在施术2h、术后第1,3天CD3+、CD4+及CD4+/CD8+均较麻醉前明显下降(P＜0.05),但C组的CD4+/CD8+在第3天已恢复(P＞0.05)并高于A,B组(P＜0.05);术后第5天,C组CD3+、CD4+及CD4+/CD8+接近麻醉前水平(P＞0.05),且高于A,N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sIL-2R和T淋巴细胞亚群的影响,有利于肿瘤病人功能的恢复.

EFFECTS OF DIFFERENT ANESTHESIA ON SERUM sIL-2R AND T-LYMPHOCYTE SUBSETS IN PATIENTS WITH GASTRIC CANCER UNDERGOING RADICAL GASTRECTOMY

Objective:To explore the effects of different anesthetic drugs and techniques on serum sIL-2R and T-lymphocyte subsets in Patients with gastric cancer undergoing radical gastrectomy.Methods:36 cases of patients undergoing radical gastrectomy were randomly divided into three groups: epidural anesthesia group (Group A), general anesthesia group (Group B), and combination of epidural anesthesia and general anesthesia group (Group C). The levels of sIL-2R and T-lymphocyte subsets were measured respectively at 2h before anesthesia, before and after skin incision and on the 1st, 3rd and 5th day after operation.Results:The serum sIL-2 and T-lymphocyte subsets were not of significant differences among three groups before anesthesia and skin incision. Serum sIL-2R increased at 2h after skin incision and on the 1st and 3rd day after operation in the group A and B (P＜0.01), and it was higher than that of group C at 2h after skin incision and on the 1st day after operation (P＜0.01). Serum sIL-2R increased at 1st postoperative day in the group C. CD3+, CD4+ and CD4+/CD8+ in all groups decreased significantly at 2h after skin incision、 on the 1st and 3rd day after operation (P＜0.05). But in the group C, CD4+/CD8+ had almost returned to baseline values on the 3rd day after operation (P＞0.05), and significantly higher than that of group A and B (P＜0.05). On the 5th day after operation, CD3+, CD4+ and CD4+/CD8+ had returned to baseline values before anesthesia in the group C (P＞0.05), and higher significantly than that of group A and B (P＜0.05).Conclusions:Epidural anesthesia combined with general anesthesia might reduce the stress reaction and the effect of anesthetic drugs on sIL-2 and T-lymphocyte subsets, contributed to restore the immune function in the patient with cancer.