两种血液稀释方法对直肠癌患者围术期T淋巴细胞亚群的影响

目的比较急性非等容性血液稀释（ANIH）和急性高容性血液稀释（AHH）联合控制性降压（CH）对直肠癌患者T淋巴细胞亚群的影响.方法选择ASAⅠ～Ⅱ级,择期直肠癌根治术（Mile’s）患者45例,年龄38～67岁,体重50～78 kg,随机分为3组,每组15例,对照组（Ⅰ组,常规输液组）,ANIH组（Ⅱ组）,AHH＋CH组（Ⅲ组）.分别于麻醉前1 h（T）1、术毕即刻（T）2、术后第1天（T）3、第4天（T）4抽取静脉血,测定T淋巴细胞亚群的变化.结果与正常人群比较,T1时三组CD3＋,CD4＋,CD4＋/CD8＋均明显降低（P〈0.05）,CD8＋增高（P〈0.05）,组间差异无统计学意义（P〉0.05）.与T1时比较,Ⅰ组T2、T3时CD3＋、CD4＋、CD4＋/CD8＋均显著降低（P〈0.05）;Ⅱ组、Ⅲ组仅T3时降低,与Ⅰ组相比差异有显著性（P〈0.05）,Ⅱ组、Ⅲ组间差异无统计学意义（P〉0.05）;T4时三组CD3＋、CD4＋均恢复至术前水平,但Ⅰ组CD4＋/CD8＋显著低于Ⅱ组、Ⅲ组（P〈0.05）.结论术前急性非等容量血液稀释（ANIH）与急性高容性血液稀释联合控制性降压均可改善围术期T淋巴细胞免疫功能.

Effects of Different Hemodilution Techniques on T-lymphocyte Subsets of Patients with Rectal Cancer in Peroperative Period

Objective To evaluate the effects of acute non-normolvolemic hemodilution（ANIH）and acute hypervolemic hemodilution（AHH）combined with controlled hypotension（CH）on T-lymphocyte subsets in patients undergoing rectal cancer surgery.Methods 45 ASA Ⅰ～Ⅱpatients aged 38～67 yr,weighing 50～78 kg,undergoing elective rectal cancer surgery were randomly divided into three groups（n=15）：GroupⅠ,control group,GroupⅡ,acute non-normolvolemic hemodilution（ANIH）group and GroupⅢ,acute hypervolemic hemodilution combined with controlled hypotension（AHH＋CH）group.The venous blood samples were taken at 4 time points which were at 1 h before the anesthesia（T1）,at the end of the surgery（T2）,on the first day and the forth day after surgery（T3,T4）to measure T-lymphocyte subsets.Results Compared with normal value,CD3＋,CD4＋,CD4＋/CD8＋ in three groups were obviously decreased（P0.05）,but CD8＋ were obviously increased（P0.05）at 1 h before operation.Compared with that at T1 time poin,CD3＋,CD4＋,CD4＋/CD8＋ in group Ⅰdecreased at T2、T3 time point（P0.05）,but those in group Ⅱ、Ⅲdecreased obviously only at T3 time point（P0.05）,and there was significant difference between groupⅠand groupⅡ,Ⅲ（P0.05）.At T4 point,CD3＋,CD4＋,CD4＋/CD8＋ in three groups recovered,but CD4＋/CD8＋ in groupⅠ were obviously lower than that in groupⅡ,Ⅲ（P0.05）.Conclusion The immunity of rectal cancer patients are suppressed before operation.Acute hypervolemic hemodilution（AHH）combined with controlled hypotension（CH）and acute non-isovolemic hemodilution（ANIH）can improve the immunity of rectal cancer patients.