不同全麻对口腔恶性肿瘤患者免疫功能的影响  

Effects of different general anesthesia protocols on immune function in patients with oral malignant tumor

作　　者：张铁军[1] 王焱林[1] 陈焰[2] 刘可斌[2] 

机构地区：[1]武汉大学中南医院麻醉科,430071 [2]武汉大学口腔医院麻醉科

出　　处：《中华麻醉学杂志》2011年第6期657-660,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价不同全麻对口腔恶性肿瘤患者免疫功能的影响。方法择期拟行口腔恶性肿瘤根治术患者60例，年龄49～64岁，体重50～71kg，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将患者随机分为3组（n=20）：Ⅰ组采用全凭静脉麻醉，静脉注射咪达唑仑、瑞芬太尼、顺阿曲库铵和异丙酚麻醉诱导，静脉输注异丙酚和瑞芬太尼维持麻醉；Ⅱ组采用静吸复合麻醉，麻醉诱导同Ⅰ组，吸入七氟醚或静脉输注异丙酚复合瑞芬太尼维持麻醉；Ⅲ组采用吸入全麻，吸人七氟醚，静脉注射瑞芬太尼和顺阿曲库铵麻醉诱导，吸入七氟醚，静脉输注瑞芬太尼维持麻醉。于麻醉诱导前30min（L）、麻醉后1、3、5h、术毕、术后24、48、72h（T2-7）时采集外周静脉血，采用流式细胞仪测定T淋巴细胞亚群及NK细胞、B淋巴细胞百分比。结果与T0时比较，Ⅰ组～Ⅲ组L～，时CD3^＋、CD4^＋、CD4^＋、CD8^＋比值、NK细胞百分比和B淋巴细胞百分比降低，Ⅱ组和Ⅲ组B时CD3^＋、CD4^＋、CD4^＋／CD8^＋比值及NK细胞百分比降低（P〈0．05或0．01）；与Ⅰ组比较，Ⅱ组T2。时CD4^＋、CD4^＋／CD8^＋比值和Ⅲ组T1～6时CD3^＋、CD4^＋、CD4^＋／CD8^＋比值及NK细胞百分比降低（P〈0．05或0．01）；与Ⅱ组比较，Ⅲ组L，时CD4^＋、CD4^＋/CD8^＋比值及NK细胞百分比降低（P〈0．05）。结论与吸入麻醉和静吸复合麻醉比较，咪达唑仑、瑞芬太尼和异丙酚全凭静脉麻醉对口腔恶性肿瘤患者免疫功能的抑制程度较低。Objective To investigate the effects of different general anesthesia protocols on immune function in patients with oral malignant tumor. Methods Sixty ASA Ⅰ or Ⅱ patients undergoing elective radical operation for oral malignant tumor were randomly divided into 3 groups （ n = 20 each） ： group Ⅰtotal intravenous anesthesia （TIVA） ; group Ⅱ combined intravenous-inhalational anesthesia （IV-INH） and group m inhalational anesthesia （INN）. Anesthesia was induced and maintained with propofol and remifentanil in group Ⅰ; with sevoflurane, propofol and remifentanil in group Ⅱ and with sevoflurane and remifentanil in group Ⅲ . Peripheral venous blood samples were taken at 30 min before （To ） and 1 h （T1）, 3 h （T2） and 5 h （T3 ） after induction of anesthesia, the end of operation （T4 ） and at 24 h （T5 ）, 48 h （T6 ） and 72 h （T7 ） after operation for determination of the percentages of T lymphocyte subsets （CD3^＋ , CD4^＋ , CD8^＋ , CD4^＋/CD8^＋ ratio）. Natural killer （NK） cells （CD16^＋ , CD56 ＋ ） and B lymphocyte （CD19＋） with flow cytometer. Results The percentages of CD3 ^＋ , CD4^＋ , NK cells, B lymphocyte and CD4^＋/CD8 ^＋ ratio were significantly decreased during and after operation at T15 in all groups and the percetttges of CD3^＋ ,CD4^＋ ,NK cells and CD4^＋ /CD3^＋ ratio were decreased at T6 in groups Ⅱ and Ⅲ as compared with the baseline values before anesthesia at To The percentage of CD4^＋ cells and CD4^＋/CD8^＋ ratio were significantly lower during anesthesia at T2.3.6 in group Ⅱ than in group 1 ^＋ The percentages of CI）4＋ and NK cells and CD4^＋/CD8^＋ ratio were significantly higher after operation at T4.5 in group Ⅱ than in group Ⅲ . The percentages of CD3 ^＋ , CD4 ^＋ , NK cells and CD4 ^＋/CD8 ＊ ratio were significantly lower at T2,3,6 in group than in group Ⅰ , Conclusion TIVA with midazolam, propofol and remifentanil has less impact on immune function than inhalational and

关 键 词：麻醉 全身 免疫 口腔肿瘤 

分 类 号：R614[医药卫生—麻醉学]