丙泊酚与七氟醚对舌癌根治术患者NK细胞和B淋巴细胞的影响

目的比较丙泊酚与七氟醚对舌癌根治术患者外周血NK细胞和B淋巴细胞的影响。方法选择择期行舌癌根治术患者40例,男25例,女15例,年龄44~67岁,ASAⅠ或Ⅱ级。随机分为两组:丙泊酚组(P组)和七氟醚组(S组),每组20例。P组采用丙泊酚2.0~2.5mg/kg、瑞芬太尼1~2μg/kg、顺苯磺酸阿曲库铵0.15mg/kg静脉麻醉诱导,丙泊酚4~6mg·kg-1·h-1及瑞芬太尼0.2~0.3μg·kg-1·min-1静脉输注维持麻醉;S组采用8%七氟醚、新鲜气体流量5L/min吸入,瑞芬太尼1~2μg/kg、顺苯磺酸阿曲库铵0.15mg/kg静脉注射诱导,瑞芬太尼0.2~0.3μg·kg-1·min-1静脉输注及2%~3%七氟醚吸入维持麻醉。分别在麻醉诱导前30min(T0)、麻醉后1h(T1)、3h(T2)、5h(T3)、手术结束时(T4)、手术结束后24h(T5)、48h(T6)、72h(T7)采集外周静脉血,采用流式细胞仪测定外周血NK细胞(CD3-CD16+56+)及B淋巴细胞(CD3-CD19+)百分比。结果与T0时比较,T1~T5时两组CD3-CD16+56+和CD3-CD19+百分比明显降低(P0.05),T6时S组CD3-CD16+56+百分比明显降低(P0.05);T2~T6时S组CD3-CD16+56+百分比明显低于P组(P0.05),两组各时点CD3-CD19+百分比差异无统计学意义。结论与七氟醚比较,丙泊酚可维持较高的NK细胞百分比,有利于维持舌癌根治术患者免疫功能。

Comparison of the effects between propofol and sevoflurane on NK cells and B lymphocytes in patients undergoing radical operation for tongue cancer

Objective To compare the effects between propofol and sevoflurane on NK cells and B lymphocytes in patients undergoing radical operation for tongue cancer.Methods Forty patients (male 25 cases,femal 1 5 cases,aged 44-67 years,ASA Ⅰ or Ⅱ)undergoing elective radical operation for tongue cancer were randomized into 2 groups:group P received 2.0-2.5 mg/kg propo-fol,1-2 μg/kg remifentanil,0.1 5 mg/kg cis-atracurium for induction and 4-6 mg · kg- 1 · h- 1 propofol, 0.2-0.3 μg · kg- 1 · min- 1 remifentanil for maintenance; group S received 8 %sevoflurane with 5 L/min fresh gas flow,1-2 μg/kg remifentanil,0.1 5 mg/kg cis-atracurium for in-duction and 2 %-3 % sevoflurane, 0.2-0.3 μg · kg- 1 · min- 1 remifentanil for maintenance. Peripheral venous blood samples were taken at 3 0 min before (T0 )and 1 h (T1 ),3 h (T2 )and 5 h (T3 )after induction of anesthesia,the end of operation (T4 )and at 2 4 h (T5 ),4 8 h (T6 )and 7 2 h (T7 )after operation for determination of the percentages of NK cells (CD3 - CD1 6 + 5 6 + )and B lymphocytes(CD3 - CD1 9 + )by the flow cytometer.Results Compared with T0 ,the percentages of CD3 - CD1 6 + 5 6 + and CD3 - CD1 9 + in two groups were significantly decreased at T1-T5 (P <0.0 5 ),and the percentage of CD3 - CD1 6 + 5 6 + in group S was significantly decreased at T6 (P <0.0 5 ).The percentage of CD3 - CD1 6 + 5 6 + in group S were significantly lower than that in group P at T2-T6 (P < 0.0 5 ).There were no significant difference in the percentages of CD3 - CD1 9 +between two groups at the same time points.Conclusion Compared with sevoflurane,propofol can maintain a higher percentage of NK cells,and was helpful to maintain the immune function in patients undergoing radical operation for tongue cancer.