不同吸入麻醉对直肠癌手术患者免疫功能的影响

目的观察七氟醚和异氟醚吸入麻醉对直肠癌手术患者免疫功能的影响,旨在为直肠癌患者术后化疗时机的选择提供安全依据。方法选择根治性直肠癌切除术患者30例,ASAⅠ～Ⅱ级,男17例,女13例,年龄45～65岁。所有患者均无内分泌和免疫系统疾病。麻醉吸入1%～2%七氟醚（SEV组）,或1%～1.5%异氟醚（ISO组）,术中辅以靶控持续泵入瑞芬太尼1.6 ng/kg、维库溴铵（1.0～1.5）μg·kg~（-1）·min~（-1）,维持麻醉使BIS在40～60。测定患者在麻醉前（T_0）、手术开始后1 h（T_1）、术毕（T_2）、术后24 h（T_3）、术后72 h（T_4）外周静脉血IL-6、sIL-2R、TNF-α的浓度。结果吸入麻醉后2组患者IL-6、TNF-α、sIL-2R均升高,其中IL-6水平2组T_1、T_2与T_0比较均显著升高且差异有统计学意义（P〈0.05）,SEV组T_2时低于1SO组（P〈0.01）;TNF-α水平SEV组T_2、T_3较T_0时显著升高,ISO组T_3较T_0时显著升高,且T_2时SEV组高于ISO组,差异均有统计学意义（P〈0.05）。上述指标于72 h恢复至术前水平。结论直肠癌患者术后化疗时机的选择在术后72 h较为安全。

The effect of inhalation anesthesia on immune function of the rectal cancer periopertaive

Objective To investigate the effect of sevoflurane and isoflurane inhalation anesthesia on the level of interleukin -6（IL-6）,tumor necrosis factor -α（TNF-α）,soluble IL-2 receptor（sIL-2R） in rectal cancer patients undergoing surgery.Methods Thirty ASAⅠ—Ⅱrectal cancer patients（17 males,13 females,45～65 years old） with surgery were enrolled in the study.The anesthesia was maintained with sevflurane（SEV group） or isoflurane （ISO group）,assistant with remifentanil 1.6 ng/kg,vecuronium bromide（1.0～1.5）μg·kg~（-1）·min~（-1）.The levels of IL-6,TNF-α,sIL-2R were detected at the time point pre surgery（T_0）,1h（T_1 ）,end surgery（T_2）,and 24h（T_3 ）,72 h（T_4） post surgery.Results The levels of IL-6,TNF-α,sIL-2R were increased in both two groups after inhalation anesthesia,and the level of IL-6 was increased obviously in time point T_1 and T_2 than T_0（P0.05）,while the level of IL-6 was lower in time point T_2 in SEV group than ISO group（P0.01 ）.The level of TNF-αwas obviously increased in time point T_2 and T_3 than T_0in SEV group,while in ISO group,the index was increased in time point T_3（P0.05）,and it was higher in SEV group than ISO group in time point T_2（P0.05）, All indexes were dropped to preoperative level in 72 h post surgery.Conclusion It suggested that further chemical therapy should be started after 72h postoperation in rectal patients.