全麻复合硬膜外阻滞对老年患者开胸手术围术期免疫反应及细胞因子的影响  

The effects of general anesthesia combined with epidural block on immune response and cytokines at perioper-ative period in old patients undergoing thoracic surgery

作　　者：乔瑞冬[1] 张志刚[2] 王昊[1] 季中华[1] 

机构地区：[1]暨南大学医学院第三医院麻醉科,珠海市519000 [2]广东省中山市人民医院麻醉科

出　　处：《河北医药》2006年第1期15-17,共3页Hebei Medical Journal

摘　　要：目的研究硬膜外阻滞复合全麻对老年患者开胸手术围术期T细胞亚群、IL-1、IL-6及IL- 10等细胞因子的影响。方法选择择期开胸手术老年患者38例,ASA Ⅰ-Ⅱ级,随机分为两组。对照组(全麻组):芬太尼、丙泊酚、维库溴铵诱导,丙泊酚、维库溴铵、异氟醚维持;研究组(复合组):全麻方法同上;术前术中硬膜外持续输注利多卡因。两组于麻醉前(T0)、切皮后1 h(T1)和术毕(T2)、术后24 h (T3)、48 h(T4)检测外周血CD3+、CD4+、CD8+、CD23+,B细胞及单核细胞HLA-DR表达和IL-1、IL-6及IL-10的变化。同时测定外周血肾上腺素(E)、去甲肾上腺素(NE)的浓度。结果对照组切皮后1 h及术毕CD3+ 细胞下降,T3 CD4+细胞和CD4+/CD8+比值降低,研究组于T1 CD4+/CD8+升高。两组T3 CD23+、B细胞、IL-1、 IL-6和IL-10均显著升高,单核细胞HIA-DR表达显著下降。研究组在术中、术后NE值均显著低于对照组。结论硬膜外阻滞加全麻能够较好地抑制手术应激反应,抑制术后CD3+、CD4+细胞下降。Objective To observe the effects of general anesthesia combined with epidural block on T cell subgroup,T helper cell function, interleukin-1, interleukin-6 and interleukin-10 at perioperative period in old patients undergoing thoracic surgery.Methods Thirty-eight ASA Ⅰ-Ⅱ patients （age range：60 -80 yr） were randomly divided into two groups. General anesthesia group （group G） ： anesthesia was induced with fentanly, propofol and vecuronium and maintained with isoflurane, propofol and vecuronium. Complex anesthesia group （group C） ：general anesthesia was performed as in group G and continuous epidural block with 1.5 % lidocaine was added during operation. Peripheral blood CD3^＋ , CD4^＋, CD8^＋, CD23^＋, B and HLA-DR of monocytes, IL-1, IL-6 and IL-10 were measured before induction of anesthesia （T1）, 1 h after incision （T2）, 24 h （T3） and 48 h （T4） after the completion of the surgery. Peripheral blood epinephrine （E） and norepinephrine （NE） were observed in the same time. Results CD3^＋ cells decreased at T2 and CD4^＋ cells, CD4^＋/CD8^＋ ratio decreased at T3 in the group C,but not in the group G. CD4^＋/CD8^＋ ratio increased at T2 in group C. CD23^＋ , B lymphocytes increased and fluorescene expression of HLA -DR on monocytes decreased significantly in both groups. Plasma levels of IL-1, IL-6 and IL-10 increased significantly at T3, Blood NE levels in group C were significantly lower than those in group G during and after operation. Conclusion The general anesthesia combined with epidural block has a better inhibitive effect on stress response to surgery and may prevent the decreases of CD3^＋ cells and CD4^＋ cells in peripheral blood after operation.

关 键 词：全身麻醉 硬膜外麻醉 免疫反应 应激反应 细胞因子 

分 类 号：R614.2[医药卫生—麻醉学] R655[医药卫生—外科学]