丙泊酚与七氟醚对舌癌根治术患者NK细胞和B淋巴细胞的影响  

Comparison of the effects between propofol and sevoflurane on NK cells and B lymphocytes in patients undergoing radical operation for tongue cancer

作　　者：张铁军[1] 彭伟[1] 尹芳[1] 刘可斌[1] 

机构地区：[1]武汉大学口腔医院麻醉科,430079

出　　处：《临床麻醉学杂志》2016年第2期114-117,共4页Journal of Clinical Anesthesiology

摘　　要：目的比较丙泊酚与七氟醚对舌癌根治术患者外周血NK细胞和B淋巴细胞的影响。方法选择择期行舌癌根治术患者40例,男25例,女15例,年龄44-67岁,ASAⅠ或Ⅱ级。随机分为两组：丙泊酚组（P组）和七氟醚组（S组）,每组20例。P组采用丙泊酚2.0-2.5mg/kg、瑞芬太尼1-2μg/kg、顺苯磺酸阿曲库铵0.15mg/kg静脉麻醉诱导,丙泊酚4-6mg·kg^-1·h^-1及瑞芬太尼0.2-0.3μg·kg^-1·min^-1静脉输注维持麻醉;S组采用8%七氟醚、新鲜气体流量5L/min吸入,瑞芬太尼1-2μg/kg、顺苯磺酸阿曲库铵0.15mg/kg静脉注射诱导,瑞芬太尼0.2-0.3μg·kg-1·min-1静脉输注及2%-3%七氟醚吸入维持麻醉。分别在麻醉诱导前30min（T0）、麻醉后1h（T1）、3h（T2）、5h（T3）、手术结束时（T4）、手术结束后24h（T5）、48h（T6）、72h（T7）采集外周静脉血,采用流式细胞仪测定外周血NK细胞（CD3^-CD16^＋56^＋）及B淋巴细胞（CD3-CD19＋）百分比。结果与T0时比较,T1-T5时两组CD3^-CD16^＋56^＋和CD3^-CD19^＋百分比明显降低（P〈0.05）,T6时S组CD3^-CD16^＋56^＋百分比明显降低（P〈0.05）;T2-T6时S组CD3^-CD16^＋56^＋百分比明显低于P组（P〈0.05）,两组各时点CD3^-CD19^＋百分比差异无统计学意义。结论与七氟醚比较,丙泊酚可维持较高的NK细胞百分比,有利于维持舌癌根治术患者免疫功能。Objective To compare the effects between propofol and sevoflurane on NK cells and B lymphocytes in patients undergoing radical operation for tongue cancer.Methods Forty patients（male 25 cases,femal 15 cases,aged 44-67 years,ASA Ⅰ orⅡ）undergoing elective radical operation for tongue cancer were randomized into 2groups：group P received 2.0-2.5mg/kg propofol,1-2μg/kg remifentanil,0.15 mg/kg cis-atracurium for induction and 4-6 mg·kg^-1·h^-1 propofol,0.2-0.3μg·kg^-1·min^-1 remifentanil for maintenance;group S received 8% sevoflurane with 5L/min fresh gas flow,1-2μg/kg remifentanil,0.15 mg/kg cis-atracurium for induction and 2%-3%sevoflurane,0.2-0.3μg·kg^-1·min^-1 remifentanil for maintenance.Peripheral venous blood samples were taken at 30 min before（T0）and 1h（T1）,3h（T2）and 5h（T3）after induction of anesthesia,the end of operation（T4）and at 24h（T5）,48h（T6）and 72h（T7）after operation for determination of the percentages of NK cells（CD3^-CD16^＋56^＋）and B lymphocytes（CD3^-CD19^＋）by the flow cytometer.Results Compared with T0,the percentages of CD3^-CD16^＋56^＋and CD3^-CD19^＋in two groups were significantly decreased at T1-T5（P〈0.05）,and the percentage of CD3^-CD16^＋56^＋in group S was significantly decreased at T6（P〈0.05）.The percentage of CD3^-CD16^＋56^＋in group S were significantly lower than that in group P at T2-T6（P〈0.05）.There were no significant difference in the percentages of CD3^-CD19^＋between two groups at the same time points.Conclusion Compared with sevoflurane,propofol can maintain a higher percentage of NK cells,and was helpful to maintain the immune function in patients undergoing radical operation for tongue cancer.

关 键 词：丙泊酚 七氟醚 自然杀伤细胞 B淋巴细胞 舌癌 

分 类 号：R614[医药卫生—麻醉学] R739.86[医药卫生—外科学]