术前急性高量血液稀释对肿瘤病人围术期T淋巴细胞免疫功能的影响

目的　探讨术前急性高容量血液稀释 (AHH)对肿瘤患者围术期免疫功能的影响。方法　 30例ASAI～II级的胸外科手术病人随机分为AHH组 (n =15 )和对照组 (n =15 )。诱导插管后吸入 2 %～ 2 5 %异氟醚及间断静注维库溴铵维持麻醉 ,在切皮前 ,AHH组输入 6 %羟乙基淀粉液(15ml/kg ,5 0ml/min) ,对照组输入林格氏液 (15ml/kg ,5 0ml/min)。分别于稀释前、稀释后、术后 2 4h和术后 1周抽取静脉血 ,用流式细胞仪测定T淋巴细胞亚群 :CD3 、CD4 、CD8及CD4 /CD8的水平。结果　稀释前两组患者各指标无显著性差异P >0 0 5 ) ;稀释后 ,AHH组CD3 、CD4 明显高于对照组 (P<0 0 1) ,CD8、CD4 /CD8两组比较无显著性差异P >0 0 5 ) ;术后 2 4h和术后第 7dCD3 、CD4 、CD8、CD4 /CD8两组比较均无显著性差异P >0 0 5 )。结论　术前采用 6 %羟乙基淀粉液进行急性高容量血液稀释可以改善肿瘤患者T淋巴细胞的免疫功能 ,对肿瘤患者术后T淋巴细胞的免疫功能无影响。

Influence of pre-operative acute hypervolemic hemodilution on immunity of T lymphocyte in cancerous patient during perioperative period

Objective To investigate the influence of pre-operative acute hypervolemic hemodilution(AHH) on immunity of T lymphocyte in cancerous patient during perioperative periodMethods Thirty ASA grade I-II patients ,scheduled for resection of esophagus or cardia carcinoma, were randomly allocated to two groups:AHH (n=15) and control (n=15) groupsFollowing inhalation of 2%-25% is- oflurane after intubation, before incision 6% hydroxyethyl starch solution or lactated Ringer's solution 15 ml/kg was intravenously infused at a rate of 50 ml/min in AHH group or control group ,respectivelyThe venous blood samples were taken before and immediately after the hemodilution, 24 h and 7 d after operation, to measure the subsets of T lymphocyte (CD 3, CD 4, CD 8 and CD 4/CD 8 ratio) with flow cytometryResults There were not significant differences in the baselines of subsets of T lyphocyte between both groups (P>005)After the hemodilution, compared with those in control group, the values of CD 3 and CD 4 in AHH group increased significantly (P<001), CD4 and CD 4/CD 8 ratio were kept unchanged in AHH group (P>005)One week after the operation, there were no significant differences between both groups in the values of CD 3, CD 4, CD 8 and CD 4/CD 8 ratio(P>005)Conclusions The AHH with 6% hydroxyethyl starch solution can improve the immunity of T lymphocyte in cancerous patient during operative period, and does not affect the immunity of of T lymphocyte in postoperative period