不同麻醉方法对肺癌患者围术期T淋巴细胞亚群的影响

Effect of different anesthetic techniques on perioperative changes in T-lymphocyte subsets in patients with pulmonary cancer

目的探讨不同麻醉方法对肺癌患者围术期T淋巴细胞亚群的影响。方法30例择期行肺叶切除术的肺癌患者,随机分为两组,Ⅰ组为全麻组,Ⅱ组为硬膜外阻滞复合全麻组,每组15例。两组分别于麻醉前(T1)、麻醉后(T2)、术毕(T3)、术后1d(T4)、术后3d(T5)测外围血T淋巴细胞亚群的变化。结果两组患者麻醉后、术毕、术后1d时CD3、CD4、CD8及CD4/CD8均较麻醉前下降(P<0.05),术后3dⅡ组指标恢复接近麻醉前水平,Ⅰ组各项指标仍低于麻醉前水平。两组指标相比有显著差异性(P<0.01)。结论硬膜外阻滞复合全麻能减轻围术期的应激反应及麻醉药物对T淋巴细胞亚群的抑制,有利于胸科肿瘤患者免疫功能的及早恢复。

Objective To study the effects of different anesthetic techniques on perioperative changes in T-lymphocyte subsets in patients with pulmonary cancer. Methods 30 patients with pulmonary cancer need pulmonary lobectomy had been randomly average assigned into two groups, general anesthesia group （group Ⅰ）,and general anesthesia combined with epidural anesthesia group （group Ⅱ ）. Peripheral blood T-lymphocyte subsets were measured before induction （T1）, after anesthesia（T2）, end of operation（T3）, 1d（T4）, 3d（TS） after surgery. Results CD3 ,CD4,CD8 and CD4/CD8 all decreased in two groups at T2,T3 and T4 than T1 （P〈0.05）.The index almost returned to the baseline values at T5 in group Ⅱ, while the group Ⅰ still low. The two groups ontrast had significant deviation（P〈0.01）. Conclusion Epidural anesthesia combined with general anesthetic can reduce depression of T-lymphocyte subsets induced by surgical trauma and anesthesia, and is the anesthetic technique of choice for cancer patients undergoing major operation.