两种麻醉方法对原发性肝癌围术期免疫学指标影响的检验分析

目的探讨两种麻醉方法对原发性肝癌围术期免疫学指标的影响。方法收集2010年12月至2015年12月86例原发性肝癌患者围术期临床资料,分为对照组和研究组,每组43例。对照组给予七氟醚吸入麻醉,研究组给予丙泊酚静脉麻醉,比较采用不同麻醉方法后对T淋巴细胞亚群和白细胞介素2(IL)-2、IL-6、肿瘤坏死因子α(TNF-α)的影响。结果两组患者麻醉前CD3~+、CD4~+、CD8~+、CD4~+/CD8~+、IL-2、IL-6、TNF-α水平比较,差异无统计学意义(P0.05),麻醉后两组患者CD3~+、CD8~+、IL-2水平在各时点差异均无统计学意义(P0.05)。和麻醉前(T0)比较,麻醉结束时(T1)两组患者CD4~+、CD4~+/CD8~+均显著下降(P0.05),但对照组在术后24h(T2)恢复至麻醉前水平,而研究组在T1、T2时点以上指标均较对照组高(P0.05),IL-6水平在T1、T2时点均显著高于T0时点(P0.05);和T0时点比较,TNF-α在对照组逐渐升高(P0.05),而研究组仅在T1时点升高(P0.05),T2时点恢复至麻醉诱导前。结论丙泊酚和七氟醚麻醉对原发性肝癌免疫功能均有抑制作用,但丙泊酚静脉麻醉抑制程度相对较轻,应激反应较小。

Analysis of the influence of two kinds of anesthesia methods on immunological indexes in patients with primary liver cancer during perioperative period

Objective To investigate the effects of two kinds of anesthesia methods on the immunological function of patients with primary liver cancer during perioperative period .Methods The clinical data of 86 cases of primary liver cancer from December 2010 to December 2015 were collected and divided into control group and study group ,43 cases in each group .The control group re-ceived sevoflurane inhalation anesthesia ,and the study group was given intravenous anesthesia with propofol ,the effects of different anesthesia methods on T lymphocyte subsets ,IL-2 ,IL-6 and TNF-α were compared .Results The levels of CD3+ ,CD4+ ,CD8+ , CD4+ /CD8+ ,IL-2 ,IL-6 and TNF-αin the two groups before anesthesia were not statistically significant (P>0 .05) ,there was no significant difference in CD3+ ,CD8+ and IL-2 between the two groups after anesthesia (P>0 .05) .Compared with T0(before anes-thasia) ,the two groups decreased significantly on CD4+ and CD4+ /CD8+ at the T1(end of anesthesia) segment(P<0 .05) ,but the control group returned to the pre anesthesia level in the T 2(24 h after surgery ) segment ,the indexes at the T1 and T2 segment in the study group were higher than those in the control group (P<0 .05) ,and the level of IL-6 at T1 and T2 segment were signifi-cantly higher than those at the T0 segment (P<0 .05) .Compared with T0 ,the control group increased gradually on TNF-α (P<0 .05) ,while the study group only increased at the T1 segment (P<0 .05) ,and the T2 segment was restored to the pre-anesthesia induction .Conclusion Propofol and sevoflurane could inhibit the immune function of primary hepatocellular carcinoma ,but the de-gree of inhibition of propofol is relatively light ,and with less stress response .