不同麻醉方法对乳腺癌患者围术期免疫功能的影响

目的 通过观察四种不同麻醉方法下乳癌改良根治术患者围术期T淋巴亚群、NK细胞及B细胞的变化,探讨不同麻醉方式对乳癌改良根治术患者围术期免疫功能的影响.方法 择期ASA Ⅰ～Ⅱ级女性乳腺癌根治术患者64例,随机分为四组,每组16例.Ⅰ组为吸入全麻组,Ⅱ组为全凭静脉麻醉组,Ⅲ组为吸入全麻复合硬膜外麻醉组,Ⅳ组为全凭静脉麻醉...

The influence of different general anesthesia technique on immune function in patients undergoing radical mammotomy (astoctomy)

Objective: To investigate the effects of four different methods of anesthesia on immune function during radical mammotomy.Methods: Sixty-four ASAⅠ~Ⅱ femal patients with breast cancer,scheduled for radical mammotomy,were randomly assigned to receive inhalation anesthesia(GroupⅠ,n=16),total intravenous anesthesia(TIVA)(group Ⅱ,n=16),inhalation anesthesia with epidural anesthesia(Group Ⅲ,n=16) and TIVA combined with epidural anesthesia(Group Ⅳ,n=16).After operation intravenous PICA was started in all the groups.The patients were premedicated with diazepam 10mg and atropine 0.5mg before operation.Blood samples were obtained from peripheral vein for determination of CD3+,CD4+,CD8+,CD4+/CD8+ ratio by flow cytometer before anesthesia(t0),at the end of operation(t1) and on the morning of post-operative day 1 and 3 and 7(t2、3、4).Results: There were no significant changes in B lymphocyte cells measured after anesthesia of operation(t1) as compared with the baseline values(t0) in the 4 groups.In all groups CD3+、CD4+and CD4+/CD8+ ratio measured at the end of operation(t1) decreased significantly,but in GroupⅡand Ⅳ the ratio of CD3+、CD4+and CD4+/CD8+ recovered and reached the baseline values(t0) 1 days after operation.In Group Ⅲ it recovered at 3rd day after operation(t2) But in GroupⅠ,the ratio of CD3+,CD4+and CD4+/CD8+ recovered till the seventh postoperative day.Compared with the baseline(t0) the value of NK cells decreased significantly after operation in GroupⅠand Ⅲ;but in GroupⅡand Ⅳ,it increased,and recovered on the 3rd day.Conclusion: TIVA with propofol combined with or without epidural anesthesia has less effects on patients T-lymphocyte and NK cells during radical mammotomy,while inhalation anesthesia anesthesia can inhibit patients’ immune function.TIVA with propofol combined with or without epidural anesthesia seems exert less effect on immunefunction and stress than inhalation anesthetic.