硬膜外阻滞复合全麻及术后镇痛对胃癌患者围术期T淋巴细胞亚群及NK细胞的影响  

The effect of combined general-epidural anesthesia and postoperative epidural analgesia on immune function of patients with gastric cancer

作　　者：马桂芬[1] 王世端[2] 李胜德[1] 王延秀[1] 曹灵敏[1] 

机构地区：[1]泰安市中心医院,山东泰安271000 [2]青岛大学医学院附属医院,山东青岛266003

出　　处：《泰山医学院学报》2006年第3期219-221,共3页Journal of Taishan Medical College

摘　　要：目的观察硬膜外阻滞复合全麻及术后硬膜外镇痛对胃癌患者围术期免疫功能的影响。方法选择36例ASAⅠ～Ⅱ级择期行胃癌根治术病人,随机分为三组,每组12例。Ⅰ组为全麻组,Ⅱ组为硬膜外阻滞复合全麻组,Ⅲ组为硬膜外阻滞复合全麻+PCEA组。三组分别于麻醉前(TO)、术毕(TI)、术后1天(T2)、术后3天(T3)、术后5天(T4)及术后7天(T5)六个时间点取外周静脉血2ml,用流式细胞仪测定T淋巴细胞亚群及NK细胞的变化。结果三组术毕及术后1天CD_3^+、CD_4^+、CD_8^+、CD_4^+/CD_8^+及NK细胞活性均明显下降,P＜0．05；术后1天下降较为显著,与诱导前比,Ⅰ组P＜0．01,Ⅱ、Ⅲ组P＜0．05。术后3天,Ⅲ组T淋巴细胞亚群及NK细胞活性基本恢复(P＞0．05),术后5天,ⅡⅢ组各项指标恢复至术前水平(P＞0．05),术后7天三组数据均恢复至术前水平。结论硬膜外阻滞复合全麻及术后硬膜外镇痛能减轻胃癌患者围术期免疫功能的抑制,缩短免疫抑制的时间。Objective： To investigate the effects of epidural block and epidural analgesia on immune function of patients with gastric cancer. Methods： Thirty-six ASA Ⅰ～Ⅱ patients undergoing elective radical operation for gastric cancer, were randomly assigned into three groups （ n = 12 ） ： General anaesthesia （ group Ⅰ ） and general combined epidural anesthesia （ group Ⅱ ） and general combined epidural anesthesia and PCEA （ group Ⅲ ）. Peripheral blood samples were taken before induction of anesthesia （T0）, at the end of operation （T1） and on the first（T2）, the third（T3 ）, the fifth（T4） and the seventh （ T5 ） day after operation to measure T-lymphocyte subsets （ CD3^＋ , CD4^＋ CD8^＋ , CD4^＋ / CD8^＋ ） , and natural kill cell counts by flow cytometry （FACScalibur FA242 USA）. Results： The CD3^＋ ,CD4^＋ ,CD8^＋ ,CD4^＋/CD8^＋ and NK ceils decreased significantly at the end of operation and the first postoperative day in three groups compared with those at base line. （ P 〈0.05 ） The values further decreased in group Ⅰ （ P 〈0.01 ） and in groupⅢ and Ⅱ （P 〈0. 05 ） on the 1st postoperative day. In group Ⅲ and Ⅱ , CD3^＋ ,CD4^＋ ,CD8^＋ ,CD4^＋/ CD8^＋ and NK cells almost returned to baseline values on the third and fifth postoperative day respectively. In group Ⅰ, CD3^＋ ,CD4^＋ ,CD8^＋ ,CD4^＋/CD8^＋ and NK ceils were close to baseline values on the seventh postoperative day. On the fifth postoperative day, CD3^＋ , CD4^＋ ,CD8^＋ ,CD4^＋/ CD8^＋ and NK ceils were significantly higher in group Ⅲ than those in group Ⅰ （ P 〈0.05 ）. Conclusion ： Perioperative epidural anesthesia and epidural analgesia of post-operation combined with general anesthesia can improve the immunosuppression of the gastric cancer patients, which can promote the recovery of patient＇s immune function.

关 键 词：硬膜外阻滞 全麻 术后镇痛 胃癌 免疫功能 

分 类 号：R614[医药卫生—麻醉学]