麻醉方法对肝炎肝硬化手术患者免疫功能的影响  

Influence of anesthesia on immune function in patients with liver cirrhosis

作　　者：殷国平[1,2] 胡万进[1] 张维峰[2] 王佳[2] 仲艳玲[2] 

机构地区：[1]南京医科大学公共卫生学院,江苏省210029 [2]南京市第二医院麻醉科

出　　处：《江苏医药》2013年第11期1284-1286,共3页Jiangsu Medical Journal

基　　金：南京市医学科技发展项目(YKK1108)

摘　　要：目的探讨麻醉对肝炎肝硬化患者围术期免疫功能的影响。方法择期行脾切除断流手术的肝炎肝硬化患者40例,ASAⅠ-Ⅱ级,Child-Pugh A-B级,随机均分为两组。均用全麻:麻醉诱导采用咪唑安定0.05mg/kg,顺式阿曲库铵0.15mg/kg,芬太尼2μg/kg;麻醉维持用雷米芬太尼0.1-0.3μg.kg-1.min-1和顺式阿曲库铵0.06-0.12mg.kg-1.h-1泵注。S组麻醉诱导加用8%七氟醚吸入,麻醉维持加用2%-4%七氟醚吸入;P组麻醉诱导加用丙泊酚,其后持续输注丙泊酚3-6mg.kg-1.h-1维持麻醉。分别于麻醉前30min(T0)、手术结束时(T1)及术后1d(T2)采静脉血2ml,用流式细胞术测定CD4+和CD8+,计算CD4+/CD8+比值。结果麻醉前两组CD4+、CD8+及CD4+/CD8+比值均。无统计学差异(P>0.05)。与T0比较,T1时两组CD4+和CD4+/CD8+比值均明显下降(P<0.05),但S组T2时已恢复至麻醉前水平。T1、T2时,S组CD4+和CD4+/CD8+比值均明显高于P组(P<0.05)。两组围术期CD8+均无明显改变(P>0.05)。结论肝炎肝硬化患者全麻下脾切除断流手术后免疫功能明显抑制。与丙泊酚比较,以七氟醚吸入为主的全麻对T淋巴细胞抑制较轻。Objective To investigate the effect of anesthesia on immune function in patients with liver cirrhosis undergoing surgery. Methods Forty patients with liver cirrhosis （ASA I- Ⅱ, Child-Pugh A-B） undergoing spleneetomy and devascularization under general anesthesia were equally randomized into two groups. Anesthesia was induced with midazolam 0. 05 mg/kg, fentanyl 2/lg/kg and cisatracnrium 0. 15 mg/kg and maintained with remifentanil 0. 1-0. 3 μg .kg^-1 rain-1 and cisatracurium 0. 06-0. 12 mg. kg^-1. h^-1. The patients in group S were given additional 8% sevoflurane inhalation during induction and 2 %-4 % sevoflurane for anesthesia maintenance. The patients in group P were given additional propofol injection for induction and propofol 3-6 mg . kg^-1. h^-1 for anesthesia maintenance. The venous blood samples were collected before anesthesia（T0）, at the end of surgery （T1） and 1 day （T2） after surgery for detecting CD4^＋ and CD8^＋ and calculating the ratio of CD4^＋ to CD8^＋ using flow cytometry. Results There were no significant differences in CD4^＋ , CD8^＋ and the ratio of CIM＋ to CD8^＋ between two groups at TO. Compared with T0,CD4^＋ and the ratio of CD4^＋ to CD8^＋ were significantly lower in two groups at T1 （P〈0. 05）, which at T1 and T2 were higher in group S than those in group P（P〈0. 05）. There were no significant differences in CD8^＋ in two groups perioperatively（P〈0. 05）. Conclusion The cell immune function is depressed in the patients with liver cirrhosis undergoing splenectomy and devascularization under general anesthesia. Compared with propofol, sevoflurane anesthesia has less immunosuppressive effect.

关 键 词：免疫功能 全身麻醉 七氟醚 丙泊酚 肝硬化 

分 类 号：R614[医药卫生—麻醉学]