胃癌根治术中自体输血病人围术期血清新喋呤和白细胞介素-2浓度的变化  

Effects of autologous blood transfusion on serum neopterin and IL-2 levels in patients undergoing radical gastrectomy

作　　者：严敏[1] 陈钢[1] 柳子明[1] 房玲玲[1] 王屹[1] 郑周鹏[1] 

机构地区：[1]浙江大学医学院附属第二医院麻醉科,杭州市310009

出　　处：《中华麻醉学杂志》2005年第7期505-507,共3页Chinese Journal of Anesthesiology

基　　金：浙江省医药卫生科研基金资助项目(1121)

摘　　要：目的探讨自体输血胃癌根治术病人围术期血清新喋呤、白细胞介素-2(IL-2)浓度的变化。方法拟行胃癌根治术病人60例,随机分为2组:异体输血组(H组)术中输异体全血400 ml;自体输血组(A组)麻醉诱导后采集自体血400ml,同时输入琥珀酰明胶500ml,术中将采集的自体血进行回输。分别于麻醉诱导前(术前)、术毕拔管后(术毕)、术后第5天抽取静脉血,用ELISA法检测血清新喋呤和IL-2浓度。结果与术前比较,H组术毕和术后第5天时血清新喋呤、IL-2浓度降低,A 组术毕血清新喋呤浓度降低(P<0.05或0.01),术后第5天时恢复至术前水平,IL-2浓度无明显变化(P>0.05)。与H组比较,A组术毕和术后第5天时血清新喋呤浓度升高,IL-2浓度术后第5天时升高(P<0.01)。H组和A组新喋呤和IL-2浓度的相关系数分别为0.071和-0.29(P>0.05)。结论自体输血对胃癌根治术病人术后机体细胞免疫功能抑制较轻,与IL-2相比,血清新喋呤可更敏感的反映病人术后免疫功能。Objective To investigate the effects of autologous blood transfusion on serum neopterin and IL-2 concentrations after radical gastreetomy. Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes （33 male, 27 female） aged 40-65 yrs weighing 51-70 kg undergoing radical gastroctomy for stomach cancer were randomly divided into 2 groups （ n = 30 each） ： homologous blood transfusion group （H） and autologous blood transfusion group （A）. The patients were premeditated with intramuscular diazepam 10 mg and atropine 0.5 mg. Anesthesia was induced with midazolam 0.1 mg·kg^-1 , fentanyl 5 μg· kg^- 1 , propofol 1 mg·kg^- 1 and vecuronium 0.12 mg·kg^-1 and maintained with isoflurane inhalation （1%-2%） and intermittent i.v. boluses of fentanyl and vecuronium. In group H homologous blood 400 ml was infused during gastro-intestinal anastomosis. In group A 400 ml of blood was removed from radial artery, after induction of anesthesia, before surgery.. Blood volume was maintained by simuhaneous infusion of succinylated gelatin 500 ml. The 400 ml autologous blood was infused also during gastrointestinal anastomosis. Venous blood samples were taken before operation （baseline）, at the end of operation and on the 5th postoperative day for determination of serum concentrations of neopterin and IL-2 （ELISA） Results The two groups were comparable with regard to sex （M/F ratio）, age, body weight, duration of operation and total blood loss. The serum concentrations of neopterin and IL-2 were significantly decreased after operation compared to the baseline values before operation in group H （P 〈 0.05, 0.01 ） while in group A only serum neopterin concentration was significantly decreased at the end of operation compared to the baseline value before operation and returned to the preoperative level on the 5th day after operation and there was no significant change in serum IL-2 concentration after operation. The serum neopterin and IL-2 concentrations were significantly higher after operation in group A

关 键 词：胃癌根治术 自体输血 围术期 血清 新喋呤 白细胞介素-2 免疫功能 

分 类 号：R735.2[医药卫生—肿瘤] R730.56[医药卫生—临床医学]