体外循环心内直视手术对患者外周血白细胞中性粒细胞T淋巴细胞亚群影响

选择３０例择期心内直视术患者，治疗期间连续观察麻醉前后、术毕、术后第１、７、１４天其外周血白细胞、中性粒细胞、Ｔ淋巴细胞亚群变化，借以判断麻醉与体外转流手术后上述免疫参数变化，为及时防治心内直视术患者术后并发症提供实验依据。结果发现静吸复合麻醉近１ｈ后外周血淋巴细胞数急剧下降，术毕、术后第１至１４天外周血白细胞、中性粒细胞数及其所占百分率显著升高，而淋巴细胞数及其百分率则明显下降。Ｔ淋巴细胞亚群分析发现麻醉后ＣＤ＋３、ＣＤ＋４细胞及ＣＤ＋４／ＣＤ＋８比值明显下降，术毕、术后第１天进一步下降，至术后第７天或１４天恢复至麻醉前水平，这些参数变化是患者术后易并发感染等的原因之一。

Alteration of Peripheral Leukocytes, Neutrophil Counts, and Lymphocyte Subsets in Patients Following Cardiopulmonary Bypass

To study the effects of cardiopulmonary bypass (CPB) and anesthesia on peripheral white blood cells, neutrophil, and T lymphocyte subpopulations, we measured simultaneously the changes of leukocyte, neutrophil counts and T lymphocyte subset phenotype before and after anesthesia, just after CPB, on the postoperative days of 1,7,14 in thirty patients undergoing open cardiac surgery. The results show that there was a sharp drop in peripheral lymphocyte counts in nearly one hour following anesthesia. Within postoperative 2 weeks, white blood cell and neutrophil counts as well as their percentages were significantly increased, while lymphocyte level and its percentage statistically reduced. T lymphocyte subsets were measured using monoclonal antibodies. CD 3, CD 4 lymphocytes and ratio of CD 4/CD 8 markedly decreased after anesthesia, on the postoperative days of o and 1,they returned to the preanesthetic levels on the 7th or 14th day postoperatively. It is concluded that the changes of the immunological indices mentioned above may be one of the reasons why the patients are susceptible to infectious complications after open heart surgery.