术中输注不同胶体液对食管癌术后免疫功能的影响  

Effects of different colloidal solution injected during operation on esophageal cancer patients' immunological function after operation

作　　者：贺红侠[1,2] 赵妍丽[3] 杨小霖[1] 

机构地区：[1]川北医学院附属医院麻醉科,四川南充637000 [2]成都医学院第一附属医院麻醉科,四川成都610000 [3]川北医学院附属医院肿瘤科,四川南充637000

出　　处：《川北医学院学报》2013年第6期544-548,共5页Journal of North Sichuan Medical College

基　　金：四川省卫生厅资助项目(070292)

摘　　要：目的：对比研究术中输注羟乙基淀粉注射液（hydroxyethylstarch injection，HES）、聚明胶肽注射液（polygeline injection, PG）及复方氯化钠注射液（ringer＇s solution，RS）对食管癌术后T淋巴细胞及亚群、IL-2、IL-6、TNF-α的影响。方法：60例ASAⅠ-Ⅱ级食管癌患者随机分为H、P、R三组，每组20例，术中按33 mL/kg分别输注HES、PG、RS。于麻醉前（d0），术后第1天（d1）、第3天（d3）、第7天（d7）分别测定外周静脉血T淋巴细胞及亚群、 IL-2、IL-6、TNF-a的含量。结果：三组患者术前各指标差异无统计学意义。H、P、R组CD3术后d1（45±9、45±7、46±9）及d3（56±12、56±10、49±11） 分别低于d0（59±10、63±8、63±6），P﹤0.05。H、P、R组CD4术后d1（25±8、21±7、25±7）及d3（35±7、33±5、31±6）分别低于d0（40±9、40±7、42±9），P〈0.05。P组CD4术后d1低于R组 （P﹤0.05）；H组和P组术后d3 CD3、CD4均高于R组 （P﹤0.05）。IL-2 在H组术后d1、d3、d7（49±10、50±12、53±9）均高于R组（42±7、42±11、48±10），P﹤0.05。 TNF-α在H组术后d1、d3、d7呈下降趋势，在P组术后d1、d3呈上升趋势，与R组比较均有统计学差异，P﹤0.05。IL-6三组术后d1均升高、d3开始回落，d7恢复至d0水平，P组与R组比较有统计学差异，P﹤0.05。 结论：术中输注HES对食管癌术后免疫功能有一定改善作用，不刺激机体炎症反应。PG对食管癌术后优势细胞免疫功能可产生一过性抑制，但很快恢复，同时可使机体炎性细胞因子增多。食管癌患者术中胶体液选择，以HES为优。Objective：To compare and study the effects of Hydroxyethyl Starch Injection （HES）, Polygeline Injection （PG） and Ringer＇s solution（RS） on T lymphocytes,T cell subgroup,IL-6,IL-2 and TNF-α in patients after esophageal carcinoma surgery. Meth-ods：Sixty ASA Ⅰ - Ⅱ patients with esophageal carcinoma were randomly assigned to three groups, and there are 20 patients in each group. 33 ml/kg of HES （ group H） , PG （ group P） or Ringer＇s solution （ group R） was injected during surgery respectively. The T lym-phocytes,T cell subgroup, IL-6, IL-2 and TNF-α in peripheral venous blood were measured before anesthesia （d0） , on the first day （dl） ,the 3rd day （d3） and the 7th day （d7） after operation. Results：No significant differences were found in all measurement inde-xes among the 3 groups before the surgery. The respective count of CD3 in group H, P and R on dl was 45 ± 9,45 ± 7and 46 ± 9, and on d3 was 56 ± 12,56 ± 10 and 49 ,± 11 ,which are lower than the count in corresponding group on d0（59 ± 10,63 ± 8,63 ,± 6） （P 〈0. 05）. The count of C D4 in group H,P and R on d l was 25 ±8,21 ±7 and 25 ±7,and on d3 was 35 ±7,33 ±5 and 31 ±6,which are lower than the count in corresponding group on dO （40 ±9,40 ±7,42 ±9） （P 〈0.05）. The count of CD4 in group P was lower than that in group R on dl （P 〈 0. 05）. The counts of CD3, CD4 in group H and group P were higher than those in group R on d3 （P 〈 0.05）. The count of IL-2 on dl ,d3 and d7（49 ± 10,50 ± 12,53 ±9） in group H was higher than the count in group R（42 ± 7,42 ± 11,48 ± 10） ,P 〈0. 05. The count of TNF-c± descended in group H on dl ,d3 and d7,but ascended in group P on dl and d3. The count of TNF-α in Group H, as well as in group P, had statistical differences compared to group R （ P 〈 0. 05 ）. The count of IL-6 ascended in each group on dl,declined on d3 and restored to normal on d7. Compared with group R,the count of IL-6 in Group P had statistical d

关 键 词：羟乙基淀粉注射液 聚明胶肽注射液 食管癌 免疫功能 

分 类 号：R614[医药卫生—麻醉学]