全麻下经胸食管癌切除前后病人外周血TNF、T淋巴细胞及其亚群的改变

Perioperative changes of TNF,lymphocyte subsets in patients undergoing resection of esophagus carcinoma

目的:探讨全麻下经胸食管癌切除术病人对免疫功能的影响。方法:以APAAP法检测75例食管癌病人术前、全麻60分钟、术后第1天、7天外周血T细胞亚群及血浆中TNF水平的变化;35例为健康对照。结果:食管癌病人CD_3^+、CD_4^+、CD_4^+/CD_8^+明显低于健康人,术中各指标变化不明显,术后1天继续下降(P<0.05),术前CD_8^+及TNF明显高于健康人(P<0.05),围手术期TNF的波动不明显,术后7天T细胞亚群及TNF趋于恢复。结论:全麻剖胸手术能加剧食管癌病人业已紊乱的免疫机能,术后应对病人采取改善免疫机能的措施。

Objective: To evaluate the perioperative changes of TNF and lymphocyte subsets in patients undergo ing resection of esophagus carcinoma. Method: The 75 patients underwent esophagectomy, and 35 healthy people served as control . The peripheral venous samples were taken before operation 60 minutes following anesthesia, the first and seventh day after operation. Result: CD_3^+, CD_4^+, CD_4^+/CD_8^+ratio were lower, CD_8^+ and TNF were higher in patient than the control levels (P<0.05). The lymphocyte subsets level was decreased further (P<0.05) on the first day after operation. The levels of TNF and the lymphocyte subsets recoved to the baseline on the seventh day after esophagectomy. Conclusion: Anesthesia and operative trauma can aggravate the immune disturbances in patients with esophageal carcinoma