丙泊酚联合瑞芬太尼麻醉肝硬化患者围手术期免疫功能的观察  

Investigate the change of T lymphocytes and NK cells in liver cirrhosis patients during splenectomy after intravenous anesthesia

作　　者：毕振华[1,2] 任波[2] 董刚[2] 徐晨[2] 刘霞[2] 米卫东 

机构地区：[1]解放军医学院解放军总医院麻醉科,北京100853 [2]解放军第302医院麻醉科

出　　处：《临床麻醉学杂志》2013年第3期232-234,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察丙泊酚联合瑞芬太尼静脉全麻对肝硬化合并门脉高压患者行脾切除门奇静脉断流术围术期外周血T淋巴细胞亚群和自然杀伤细胞(NK细胞)的影响。方法选择择期行脾切除门奇静脉断流术的肝硬化患者20例,ASAⅠ或Ⅱ级,静脉注射丙泊酚联合瑞芬太尼麻醉。分别于麻醉前(T0)、切皮前(T1)、手术开始后30min(T2)、90min(T3)、手术结束(T4)、术后1d(T5)、7d(T6)采集患者外周静脉血2ml,采用流式细胞仪测定CD3+、CD4+、CD8+T淋巴细胞、NK细胞绝对数量。结果与T0时比较,T1时CD3+、CD4+、CD8+T淋巴细胞和NK细胞均明显降低(P<0.01),T2时基本恢复至T0时水平;T3、T4时CD3+、CD4+、CD8+T淋巴细胞和NK细胞明显降低(P<0.01)。T6时CD3+、CD4+、CD8+T淋巴细胞明显多于T0～T5时,T3～T5时NK细胞明显少于T0时(P<0.01)。结论丙泊酚联合瑞芬太尼麻醉对门脉高压患者行脾切除门奇静脉断流术,T淋巴细胞和NK细胞有快速、短期的降低作用,术后7dT淋巴细胞数量不仅得到恢复,并且反馈性地升高,但是NK细胞仅恢复到术前正常水平。Objective To investigate the impact of general anesthesia of propufol combined with remifentanil on the absolute number of peripheral T lymphocytes and NK cells in liver cirrhotic patients with portal hypertension subjected to spleneetomy and portal azygos disconnection. Methods Twenty liver cirrhotic patients with portal hypertension （ASA Ⅰ/Ⅱ） subjected to splenectomy and portal-azygos disconnection were enrolled and anaesthetized with propofol combined with remifentanil. 2ml of peripheral venous blood was collected before anesthesia （T0）, before skin incision （T1）, at 30 min after the start of surgery （T2）, at 90 rain after the start of surgery （T3）, at the end of the surgery （T4）, 1 d after surgery （T5） and 7d after surgery （T6）, respectively to measure the absolute numbers of CD3＋, CD4＋, CD8＋T cells and NK cells by flow cytometry. Results Absolute numbers of CD3＋,CD4＋,CD8＋T cells and NK cells were significantly lower at T1 than that at To （P〈0.01）. The number of these cells at T2 increased up to the levels of T0. Along with the proceed of the surgery, the number of T cells and NK cells decreased again and kept at lower level until the end of surgery. CD3＋ ,CD4＋ and CD8＋ T cells was significantly lower at T3 ,T1 than those at To （P〈0.01）. At T6, CD3＋,CD4＋ and CD8＋T cells was significantly more than at T0-T5. At T3-T5 NK cells was significantly lower than those at To （P〈0.01）; At T6 NK cells was significantly higher than at T1- T5 （P〈0.01）. Concision The absolute numbers of peripheral T lymphocytes and NK cells decreased rapidly and temporarily following intravenous anesthesia of propofol combined with remifentanil in liver cirrbotic patients with portal hypertension subjected to splenectomy and portal azygos disconnection. At 7d after surgery, the number of T cells increased to a higher level compared to that at To and NK cells only recovered to its original level.

关 键 词：丙泊酚 瑞芬太尼 T淋巴细胞亚群 自然杀伤细胞 脾切除门奇静脉断流术 

分 类 号：R614[医药卫生—麻醉学]