丙泊酚靶控输注清醒镇静对患者围术期T细胞亚群及NK细胞的影响

目的观察丙泊酚靶控输注(TCI)清醒镇静对围术期患者T细胞亚群及NK细胞的影响。方法 30例硬膜外麻醉下行子宫切除或下肢手术的患者,ASAⅠ或Ⅱ级,随机均分为对照组和丙泊酚TCI组(TCI组)。手术前5min开始输注生理盐水或丙泊酚,手术结束前5min停止输注。流式细胞术测定输注开始(T1)、手术开始(T2)、术毕(T3)、术后24h(T4)和术后48h(T5)各时点外周静脉血T细胞亚群和NK细胞水平。结果与T1时比较,T2～T5时对照组CD3+、CD4+、(CD3++CD4+)/(CD3++CD8+)和NK细胞明显降低(P<0.05或P<0.01),T3、T4时TCI组CD3+、CD4+、(CD3++CD4+)/(CD3++CD8+)和T2～T4时NK细胞明显降低(P<0.05)。T2～T5时对照组CD3+、CD4+、(CD3++CD4+)/(CD3++CD8+)及NK细胞变化幅度大于TCI组。两组各时点CD8+差异无统计学意义。结论硬膜外麻醉复合丙泊酚TCI清醒镇静可改善患者围术期免疫功能。

Effects of conscious sedation with propofol target controlled infusion on perioperative T cell-subgroups and NK cells of the patients

Objective To investigate the effects of conscious sedation with propofol target controlled infusion (TCI) on perioperative T cell-subgroups and NK cells of the patients.Methods Thirty patients undergoing hysterectomy or lower extremity surgery with epidural anesthesia, ASA class Ⅰ or Ⅱ were equally randomized to group control and group propofol TCI(group TCI). Propofol or saline was infused from 5 minutes before the start of operation, to 5 minutes before the end of operation. T cell-subgroups and NK cells were measured by flow cytometry before sedation (T1), at the start of operation (T2), at the end of operation (T3), 24 h after operation (T4) and 48 h after operation (T5).Results Compared with T1, CD3+, CD4+, (CD3++CD4+)/(CD3++CD8+) and NK cells decreased at T2-T5 in group control (P <0.05 or P<0.01). CD3+, CD4+ and (CD3++CD4+)/(CD3++CD8+) decreased at T3 and T4, and NK cells decreased at T2-T4 in group TCI (P<0.05). The oalues of CD3+, CD4+, (CD3++CD4+)/(CD3++CD8+) and amplitude of variation of NK cells in group control at T2-T5 were higher that those in group TCI. There was no significant difference with regard to CD8+ between the two groups.Conclusion Epidural anesthesia combined with conscious sedation with propofol TCI may ameliarate the immune function of perioperative patients.