充气毯术中保温对食管癌根治术患者细胞免疫功能的影响

目的 探讨充气毯术中保温对食管癌根治术患者细胞免疫功能的影响.方法择期拟行食管癌根治术患者36例,性别不限,年龄≤64岁,体重指数＜30 kg/m2,ASA分级Ⅰ或Ⅱ级,随机分为常规保温组(C组)和充气毯术中保温组(T组),每组18例.T组患者麻醉诱导前采用充气毯保温,43℃预加热20 min,保温直至术毕.于麻醉诱导后气管插管前(T1)、诱导后30、60、120、180 min和术毕(T2-6)时测定体温,于T1,6时采用ELISA法测定血浆去甲肾上腺素、肾上腺素浓度,流式细胞仪测定外周血T淋巴细胞亚群及NK细胞百分比.结果 与T1时比较,T2-6时C组体温降低,T6时两组CD4+T细胞百分比、CD4+/ICD8+均明显降低,CD8+T细胞百分比、血浆去甲肾上腺素和肾上腺素浓度升高(P＜0.05);与C组比较,T组T2-6时体温升高,T1时血浆去甲肾上腺素和肾上腺素浓度升高,浓度变化率降低(P＜0.05).结论 充气毯术中保温效果良好,可降低应激反应,但对食管癌根治术患者细胞免疫功能无显著影响.

Abstract：

Objective To investigate the effect of forced-air warming system on the cellular immune function during radical esophagus cancer resection. Methods Thirty-six ASA Ⅰ or Ⅱ patients of both sexes, aged ≤ 64 yr, with body mass index ＜ 30 kg/m2 , scheduled for elective radical esophagus cancer resection, were randomized to 2 groups ( n = 18 each): normal temperature care group (group C) and forced-air wanning group (group T) . Anesthesia was induced with midazolam, sufentanil, propofol and vecuronium. The patients were tracheal intubated and mechanically ventilated. The patients were not warmed intraoperatively in group C. In group T, the patients were prewarmed for 20 min at 43℃, using forced-air warming system before induction and then kept warm until the end of operation. The nasopharyngeal temperature was measured at 0, 30, 60, 120 and 180 min after anesthesia induction and at the end of operation (T1-6 ) to reflect the body temperature. Venous blood samples were taken at T1,6 for analysis of T-lymphocyte subsets (CD3+ , CD4+ , CD8+ , CD4+ /CD8+ ) and NK cells (by flow cytometry) and determination of the plasma concentrations of noradrenaline and adrenaline (by ELISA) . Results Compared with T1 , the body temperature was significantly decreased at T2-6 in group C, and the percentage of CD4+ cells and CD4+ /CD8+ ratio were significantly decreased and the percentage of CD8+ and plasma concentrations of noradrenaline and adrenaline increased at T6 in both groups ( P ＜ 0.05). Compared with group C, the body temperature was significantly increased at T2-6, plasma concentrations of noradrenaline and adrenaline were significantly increased at T, , while the change rate of concentrations was significantly decreased in group T ( P ＜ 0.05) . ConclusionThe efficiency of forced-air warming system in maintaining perioperative normothermia is good and it reduces the stress response, but it exerts no influence on the cellular immune function in patients undergoing radical esophagus cancer resection.

Effect of forced-air warming system on cellular immune function during radical esophagus cancer resection

Objective To investigate the effect of forced-air warming system on the cellular immune function during radical esophagus cancer resection. Methods Thirty-six ASA Ⅰ or Ⅱ patients of both sexes, aged ≤ 64 yr, with body mass index ＜ 30 kg/m2 , scheduled for elective radical esophagus cancer resection, were randomized to 2 groups ( n = 18 each): normal temperature care group (group C) and forced-air wanning group (group T) . Anesthesia was induced with midazolam, sufentanil, propofol and vecuronium. The patients were tracheal intubated and mechanically ventilated. The patients were not warmed intraoperatively in group C. In group T, the patients were prewarmed for 20 min at 43℃, using forced-air warming system before induction and then kept warm until the end of operation. The nasopharyngeal temperature was measured at 0, 30, 60, 120 and 180 min after anesthesia induction and at the end of operation (T1-6 ) to reflect the body temperature. Venous blood samples were taken at T1,6 for analysis of T-lymphocyte subsets (CD3+ , CD4+ , CD8+ , CD4+ /CD8+ ) and NK cells (by flow cytometry) and determination of the plasma concentrations of noradrenaline and adrenaline (by ELISA) . Results Compared with T1 , the body temperature was significantly decreased at T2-6 in group C, and the percentage of CD4+ cells and CD4+ /CD8+ ratio were significantly decreased and the percentage of CD8+ and plasma concentrations of noradrenaline and adrenaline increased at T6 in both groups ( P ＜ 0.05). Compared with group C, the body temperature was significantly increased at T2-6, plasma concentrations of noradrenaline and adrenaline were significantly increased at T, , while the change rate of concentrations was significantly decreased in group T ( P ＜ 0.05) . ConclusionThe efficiency of forced-air warming system in maintaining perioperative normothermia is good and it reduces the stress response, but it exerts no influence on the cellular immune function in patients undergoing radical esophagus cancer resection.