低流量单肺通气对肺癌患者术后细胞免疫功能的影响

Effect of low-volume anesthesia and one-lung ventilationon cellular immune function after operation in patients with lung cancer

目的 了解低流量单肺通气对肺癌患者术后细胞免疫功能的影响。方法 将40例单肺通气的肺癌手术患者随机分为两组（A、B组），每组20例，两组患者均在全身麻醉单肺通气下手术，A组采用常规流量单肺通气（3L／min），B组则采用低流量单肺通气（1L／min），应用流式细胞仪分别检测两组患者手术前、术后1d和术后7d外周血T细胞亚群和NK细胞活性的变化。结果 两组患者术前CD3^＋、CD4^＋、CD4^＋／CD8^＋和NK细胞活性差异无显著性（P〉0．05）；两组病人行病灶切除术后1d，CD3^＋、CD4^＋和CD4^／CD8^较术前降低（P〈0．01），术后1周上述指标较术前升高（P〈0．01），而NK细胞活性在术后1d升高（P〈0．01），术后1周与术前相似（P〉0．05）；但两组间的比较差异无显著性（P〉0．05）．结论 与常规流量单肺通气比较，低流量单肺通气不加重肺癌患者的细胞免疫功能抑制，在临床应用是安全的。

Objective To study the effect of low-volume anesthesia and one-lung ventilation on the cellular immune function after operation in patients with lung Cancer. Methods 40 patients with lung cancer operation under One-lung ventilation were randomly divided into two groups, normal -volume anesthesia and One-lung ventilation group （group A, n = 20）, low-volume anesthesia and One-lung ventilation group（group B, n = 20, tL/min）. The T subsets and natural killer cell active from perpheral blood 40 patients with lung cancer were measured by flow cytometry, the venous blood were collected at the points of before operation, the 1st and the 7th postoperative day. Results There was no significant difference in two groups on CD3^＋ ,CD4^＋ ,CD4^＋ / CD8^＋ and natural killer cell active before operation （P〉0. 05）. Compared with before operation, CD3^＋ ,CD4^＋ and CD4^/ CD8^＋ in two groups were decreased statistically at the 1st postoperative day （P〈0. 01） and increased obviously at one week after operation （P〈 0. 01）. Natural killer cell active was increased obviously at the 1st postoperative day （P〈0.01） and no significant difference at one week after oper- ation （P〉0. 05）, but there was no significant difference in two groups （P〉0.05）. Conclusions Compared with normal-volume anesthesia and onelung ventilation group, the cellular immune function is not inhibited by low-volume anesthesia and one-lung ventilation in patients with lung cancer operation, clinical application of low-volume anesthesia and one-lung ventilation is safe.