全麻复合胸段硬膜外阻滞对不停跳冠状动脉搭桥术后患者T淋巴细胞亚群的影响

目的 观察全麻复合胸段硬膜外阻滞对不停跳冠状动脉搭桥术(OPCABG)后患者T细胞亚群及止浆皮质醇的影响.方法 22例择期行OPCABG患者随机分为全麻组(A组)和全麻复合硬膜外阻滞组(E组),每组11例,术后均采用吗啡静脉镇痛(PCIA).分别于麻醉前(T1)、术毕(T2)、术后第1天(T3)及第3天(T4)抽取外周静脉血,用流式细胞仪(FCM)检测T淋巴细胞亚群变化,以化学发光法测血浆皮质醇.结果 与T1比较,两组血浆皮质醇在T2和T3均明显升高(P＜0.05),但E组患者升高程度明显低于A组(P＜0.05).两组T2和T3 CD3 、CD4 和CD4 /CD8 均较T1明显下降(P＜0.05).但与E组比较,A组T3及T4 CD3 、CD4 、CD4 /CD8 下降更明显(P＜0.05),且E组患者T淋巴细胞亚群在T4已恢复至T1水平(P＞0.05).结论 全麻对OPCABG后患者细胞免疫功能有抑制作用,复合胸段硬膜外阻滞将减轻此抑制的程度.

Effects of general anesthesia combined with high thoracic epidural block on T-lymphocyte subsets in patients undergoing off-pump coronary artery bypass surgery

Objective To investigate the effects of general anesthesia combined with high thoracic epidural block on the T-lymphocyte subsets in the patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods Twenty-two patients undergoing OPCABG were randomly divided into two groups with 11 cases each.The patients in group A received general anesthesia only,and those in group E general anesthesia combined high thoracic epidural block.Postoperative patient-controlled intravenous analgesia(PCIA) with morphine was given in both groups.Peripheral blood samples were obtained before anesthesia(T1),at the end of operation(T2),on the 1st(T3) and 3rd postoperative day(T4).The plasma cortisol levels were measured by CLIA and T-lymphocyte subsets(CD3+,CD4+,DD8+ and CD4+/CD8+) were detected by FCM.Results Compared with those at T1,the levels of CD3+,CD4+,CD4+/CD8+ were decreased significantly at T2 and T3 in both groups(P<0.05),while the decreases in group E were less than those in group A.Compared with the baseline,the cortisol levels were increased significantly at T2 and T3 in both groups(P<0.05),but the increases of group A were higher than those of group E,which returned to the baseline at T1 in both groups.Conclusion General anesthesia combined with high thoracic epidural block in OPCABG may reduce the stress response to the surgery.