两种麻醉方法对胃癌手术患者血清T淋巴细胞亚群及炎性因子水平的影响

目的比较全身麻醉与全身麻醉复合硬膜外腔阻滞麻醉对胃癌手术患者血清T淋巴细胞亚群及白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）水平的影响。方法选择60例胃癌手术患者，按数字表法随机分为I组和Ⅱ组各30例，I组采用全身麻醉方法，Ⅱ组采用全身麻醉复合硬膜外腔阻滞麻醉方法，分别于麻醉前、麻醉后2h、术后1d和术后6d检测两组血清CD3＋、CD4＋、CD4＋／CD8＋及IL-6、IL-10、TNF-α的水平，并进行比较。结果两组麻醉后2h、术后1d血清CD3＋、CD4＋、CD4＋／CD8＋水平均较麻醉前明显下降（均P〈0．05），且I组下降水平大于Ⅱ组（P〈0.05）；两组麻醉后2h血清IL-6水平均明显升高（均P〈0．05），两组IL-10、TNF-α水平无明显变化（均P〉0．05）。术后6d两组各项观察指标均恢复至术前水平。结论全身麻醉复合硬膜外腔阻滞麻醉对胃癌手术患者术后免疫功能有一过性抑制作用，且抑制程度轻于全麻身麻醉方法，而对患者的炎性反应影响较小。

Influence of different anesthesia methods on postoperative changes in T-lymphocyte subsets and cytokines in the patients under want operation of stomach carcinoma

Objective To study the effects of different anesthesia methods on postoperative changes in T-lymphocyte subsets and IL-6、IL-10、TNF-α in the patients undergoing operation of stomach carcinoma.Methods 60 patients with stomach carcinoma were randomly divided into group I(general anaesthesia)and Ⅱ(general combined epidural anesthesia).The level of T-lymphocyte subsets and IL-6、IL-10、TNF-αt were respectively detected and compared before anesthesia,2 h after anesthesia,ld and 6 d after operation.Results CD3+ 、CD4+ 、CD4+/CD3+ decreased,but IL-6 increased at the end of 2 h after anesthesia,l d after operation compared with those before anesthesia(all P＜0.05).While IL-10、TNF-α had no statistical significance(all P＞0.05).At 6 d after operation,the values recovered to the level before anesthesia in two groups.Conclusion The immune function in patients with gastric cancer decreaseed after anesthesia,it was more serious in geteral anaesthesia than that of general combined epidural anesthesia.But anesthesia had little influence on inflammatory response.