七氟醚和丙泊酚对HIV感染患者外周静脉血T淋巴细胞亚群的影响  

Effects of sevoflurane and propofol on T lymphocyte subsets in peripheral venous blood of HIV infected patients

作　　者：张维峰[1] 殷国平[1] 王佳[1] 陈慧 冷蔚蔚 ZHANG Weifeng;YIN Guoping;WANG Jia;CHEN Hui;LENG Weiwei(Department of Anesthesiology,Affiliated Nanjing Hospital,Nanjing University of Chinese Medicine,Nanjing 210003,China)

机构地区：[1]南京市第二医院/南京中医药大学附属南京二院麻醉科,210003

出　　处：《临床麻醉学杂志》2020年第8期775-778,共4页Journal of Clinical Anesthesiology

基　　金：南京市医学发展项目(YKK17166)。

摘　　要：目的探讨七氟醚和丙泊酚全身麻醉对HIV感染患者外周静脉血T淋巴细胞亚群的影响。方法选择全麻下接受妇科及结肠肿瘤手术的HIV感染患者28例,男16例,女12例,年龄28~65岁,体重50~75 kg,ASAⅠ—Ⅲ级。随机分为两组:七氟醚组(S组)和丙泊酚组(P组),每组14例。S组术中持续吸入2%~4%七氟醚,P组持续静脉注射丙泊酚3~6 mg·kg^-1·h^-1,两组均泵注瑞芬太尼0.4~0.6μg·kg^-1·min^-1,调节麻醉深度,维持术中BIS值在40~60。分别于麻醉前30 min(T0)、气管插管时(T1)、切皮时(T2)、手术结束时(T3)及拔管时(T4)记录患者生命体征和BIS值以及手术时间和术中出入量。分别于T0、T3、术后24 h(T5)及术后3 d(T6)抽取患者外周静脉血,检测T淋巴细胞亚群(CD3^+,CD4^+,CD8^+)的含量,计算CD4^+/CD8^+比值,并检测T0、T5和T6时HIV病毒载量。结果与T0时比较,T3时两组外周静脉血CD3^+、CD4^+含量和CD4^+/CD8^+比值明显降低,CD8^+含量明显增加(P<0.05)。与P组比较,T3、T5时S组CD3^+、CD4^+含量和CD4^+/CD8^+比值明显增高,CD8^+含量明显降低(P<0.05)。两组HIV病毒载量差异无统计学意义。结论相同麻醉深度下,与丙泊酚比较,七氟醚全身麻醉对HIV感染患者T淋巴细胞亚群抑制较轻且恢复较快。Objective To investigate the effects of general anesthesia of sevoflurane and propofol on T lymphocyte subsets in peripheral venous blood of patients with HIV infections. Methods Twenty-eight HIV-infected patients undergoing gynecological and colon tumor surgery under general anesthesia were enrolled, including 16 males and 12 females, aged 28-65 years, weighing 50-75 kg, and ASA physical status Ⅰ-Ⅲ. The patients were randomly divided into sevoflurane group(group S) and propofol group(group P), 14 cases in each group. Patients in group S received continuous inhalation of sevoflurane, whereas patients in group P received continuous intravenous injection of propofol. The BIS value was monitored to measure the depth of anesthesia. The intraoperative BIS was controlled in the range of 40 to 60. Vital signs and BIS values were recorded 30 min before anesthesia(T0), tracheal intubation(T1), peeling(T2), end of surgery(T3), and extubation(T4). The operation time and the volume of bleeding and infusion during the operation were counted. The T lymphocyte subsets(CD3^+, CD4^+, CD8^+) in peripheral venous blood were detected at T0, T3, 24 h after surgery(T5), and 3 d after surgery(T6). The ratio of CD4^+/CD8^+ was calculated. The amount of HIV virus was measured in the two groups at T0, T5, and T6. Results Compared with T0, the levels of CD3^+, CD4^+ and the ratios of CD4^+/CD8^+ in peripheral venous blood of the two groups at T3 were significantly reduced, the level of CD8^+ was significantly increased(P < 0.05). Compared with group P, the content of CD3^+, CD4^+, and the ratio of CD4^+/CD8^+ in group S were significantly increased at T3 and T5, and the content of CD8^+ was significantly decreased(P < 0.05). There was no statistically significant difference between the two groups in the amount of HIV in blood samples collected at T0, T5, and T6. Conclusion Under the same depth of anesthesia, compared with propofol, general anesthesia with sevoflurane has less inhibitory effect on T lymphocyte subsets in HIV patients an

关 键 词：七氟醚 丙泊酚 HIV感染 免疫功能 脑电双频指数 

分 类 号：R614[医药卫生—麻醉学]