手术应激与免疫抑制

Surgical Stress and Immunosuppression

手术前后时期的心理应激和生理应激均可抑制细胞免疫功能,主要表现为T淋巴细胞和自然杀伤(natural killer,NK)细胞的数量减少和活性减弱。手术创伤越大,对免疫的抑制作用越强,因而对手术后的痊愈有明显影响。一般而言,手术应激所致的免疫抑制可以恢复,恢复的时间主要取决于手术创伤的大小。目前认为,手术引起免疫抑制的机制主要与下丘脑-垂体-肾上腺皮质轴、交感神经系统、细胞因子、阿片肽和T细胞信号分子有关。选用某些不具有免疫抑制作用的止痛药物,以及蛋白酶抑制剂,可以防治手术应激所致的免疫抑制作用。

Perioperative psychological and physiological stress can suppress cell-mediated immunity, including the decrease of T lymphocytes and natural killer （NK） ceils in the number and activities. A stronger immunosuppression is found in larger postoperative stress than in smaller one, which may interfere with the recovery from the surgical hurt. Generally, the surgical stress-induced immunosuppression can recover, which depends on the degree of surgical injury. The mechanisms through which surgical stress induces the immunosuppression are closely related to hypothalamus-pituitary-adrenocortical axis, sympathetic nervous system, cytokines, opioids and T cell signal molecule. Some strategies may be used to prevent surgical stress-induced immunosuppression, which includes analgesic drugs devoid of immunosuppressive effects and protease inhibitor.