不同麻醉方式对直肠癌根治术患者免疫功能的影响

目的：探讨不同麻醉方式对直肠癌根治术患者免疫功能的影响。方法将82例行直肠癌根治术的患者按照数字表法随机分为两组，各41例，A组采用全凭静脉麻醉；B组采用硬膜外阻滞复合静脉全麻。两组分别于麻醉前30 min（T0）、切皮后2 h（T1）、术后2 h（T2）和术后24 h（T3）采外周静脉血检测CD3＋、CD4＋、CD4＋/CD8＋、CD3＋HLA-DR＋和自然杀伤（ NK）细胞的表达情况。结果 A组T2、T3时VAS评分分别为（3．86±0．46）分和（3．62±0．26）分，明显高于B组的（1．67±0．57）分和（1．94±0．42）分（t＝4．624、4．841，均P＜0．05）。 CD3＋、CD4＋、CD4＋/CD8＋、CD3＋HLA-DR＋与NK细胞指标：A组麻醉后各个时点上述指标均低于麻醉前（均P＜0．05）；B组在T1、T2时上述指标均低于麻醉前（均P＜0．05）；而在T3时与麻醉前差异无统计学意义（ P＞0．05）；A组麻醉后各时点上述指标均低于B组（均P＜0．05）。结论硬膜外复合静脉全麻比全凭静脉麻醉对直肠癌患者细胞免疫抑制更轻。

Effects of different anesthesia on immune function in patients with colorectal cancer radical mastectomy

Objective To investigate the effects of different anesthesia methods on immunity in patients underwent radical resection of rectal carcinoma.Methods 82 patients underwent radical resection of rectal carcinoma were divided into two groups,each group had 41 cases.A group received total intravenous anesthesia while B group received total intravenous anesthesia combined with eqidural anesthesia.CD3＋,CD4＋,CD4＋/CD8＋,CD3＋HLA-DR＋and NK cells were inspected before induction of anesthesia（T0）,2 h after skin incision（T1）,2 h（T2） and 24 h（T3） after the end of operation.The T-lymphocyte subsets,activated T cells and NK cells were measured by flow cytometry. Visual analogue scale（VAS） was observed at T2 and T3.Results The VAS score of T2,T3 in A group（3.86 ± 0.46）points,（3.62 ±0.26）points]were higher than those in B group（1.67 ±0.57）points,（1.94 ±0.42）points] （all P〈0.05）.The percentages of CD3＋,CD4＋,CD4＋/CD8＋,CD3＋HLA-DR＋and NK cells of T1,T2,T3 were lower than those of T0 in A group（all P〈0.05）;The percentages of CD3＋,CD4＋,CD4＋/CD8＋,CD3＋HLA-DR＋and NK cells of T1, T2 were lower than those of T0 in B group （ all P 〈0.05 ）;The percentages of CD3＋, CD4＋, CD4＋/CD8＋, CD3＋HLA-DR＋ and NK cells of T1, T2, T3 in A group were lower than those in B group （ all P 〈0.05 ）. Conclusion Total intravenous anesthesia combined with eqidural anesthesia produces less immune suppression than total intravenous anesthesia.