开颅手术患者围术期的免疫状态研究  

Immune function investigation of patients undergoing craniotomy surgery

作　　者：刘淑静[1] 方芳[1] 陈柯霖[1] 吕虹[1] 康熙雄[1] 张国军[1] 

机构地区：[1]首都医科大学附属北京天坛医院检验科,100050

出　　处：《中国综合临床》2015年第3期193-197,共5页Clinical Medicine of China

基　　金：国家重点基础研究发展计划（973计划）项目（2007CB512503）

摘　　要：目的观察开颅手术患者手术期间免疫细胞计数的变化，初步探讨开颅手术患者手术期间的免疫状态。方法收集18例开颅手术患者麻醉前（11D），麻醉诱导完成后30min（T1）、45rain（他）、60min（开颅操作，T3）、120min（肿瘤切除，T4）和气管拔管前（T5）静脉抗凝血。应用流式细胞检测技术检测外周循环中免疫细胞的水平，采用SPSS13．0软件对数据进行分析。结果开颅手术期间免疫细胞数量在麻醉后迅速下降，之后逐渐恢复，在麻醉结束前粒细胞恢复至术前水平。其中嗜中性粒细胞、单核细胞、淋巴细胞在麻醉诱导后30min下降至（3．10±1．50）×10^9／L、（0．32±0．17）×10^9／L、（1．10±0．50）×10^9／L，显著低于麻醉前水平（4．50±2．00）×10^9／L、（0．51±0．22）×10^9／L、（1．90±0．70）×10^9／L，差异均有统计学意义（P均〈0．05）。淋巴细胞亚群中TS和NK细胞分别由麻醉前的（0．55±0．29）×10^9／L、（0．32±0．14）×10^9／L下降至（0．33±0．22）×10^9／L、（0．10±0．08）×10^9／L，差异有统计学意义（P均〈0．05）。结论开颅手术期间非特异性和特异性免疫细胞均受到抑制，在麻醉早期免疫系统受抑制最严重。受抑制的免疫细胞中嗜中性粒细胞恢复较快，而TS和NK细胞恢复较慢。Objective To investigate the immune cell population change during the anesthesia process in patients undergoing craniotomy surgery. Methods A total of 18 patients undergoing craniotomy who had an inhalational general anesthetic were selected as our subjects. Blood samples were collected before anesthesia （ T0 ） and 30 min （ T1 ） ,45 min （ T2 ）, 60 min （ craniotomy operated, T3 ）, 120 min （ tumor resected, T4 ） and 240 min（ T5 ） after anesthesia. Blood cell counts including nentrophils, monoeytes and lymphocytes were determined along with lymphocyte subpopulations （T cells,inducer and helper T ceils, suppressor and cytotoxic T cells, NK cells, B cells）. Data were analyzed by SPSS 13.0 software. Results In terms of the immune cell during neuroanesthesia, induction neutrophils, monocytes and lymphocytes decreased significantly from （4. 50± 2.00 ）×10^9/L, （0. 51 ±0. 22） ×10^9/L, （ 1.90 ±0. 70）×10^9/L to （3. 10 ± 1.50） ×10^9/L, （0. 32± 0. 17 ） ×10^9/L, （ 1.10 ± 0. 50）×10^9/L at the 30 min after anesthesia, and the differences were significant （ P 〈 0. 05 ）. It also showed that Ts and NK cells decreased significantly from （0. 55±0. 29） ×10^9/L, （0. 32 ±0. 14） ×10^9/L to （0. 33± 0. 22） ×10^9/L, （0. 10 ± 0. 08 ） ×10^9/L at the 30 min after anesthesia, and the differences were significant（ P 〈 0. 05 ）. Conclusion Special and non special immune system are inhibited during craniotomy, especially at the early anesthesia. Among the inhibited immune cells, neutrophils recover early and followed Ts and NK ceils.

关 键 词：淋巴细胞亚群 开颅手术 免疫抑制 

分 类 号：R651.15[医药卫生—外科学]