连续硬膜外镇痛对非停跳冠状动脉搭桥术患者T淋巴细胞亚群和自然杀伤细胞的影响

Effect of continuous epidural analgesia on T-lymphocyte subsets and natural killer cells in patients undergoing off-pump coronary artery bypass

目的：探讨连续硬膜外镇痛对非停跳冠状动脉搭桥术患者围术期T淋巴细胞亚群和自然杀伤细胞的影响。方法：选择非停跳冠状动脉搭桥术患者60例,随机分为单纯全身麻醉组（GA组）30例和全身麻醉复合连续硬膜外镇痛组（PCEA）30例。在麻醉诱导前（T0）、术后4 h（T1）、1 d（T2）、3 d（T3）、7 d（T4）5个时间点各抽取外周静脉血2mL,采用流式细胞仪测定T淋巴细胞亚群（CD3、CD4、CD8、CD4/CD8）及自然杀伤细胞（CD16＋56）的数量。结果：患者手术经过及术后恢复均顺利。T1~T2时2组T淋巴细胞亚群和自然杀伤细胞较术前显著减少（P〈0.05）,GA组较PCEA组减少更明显（P〈0.05）。T3时GA组T淋巴细胞亚群和自然杀伤细胞仍较术前减少,PCEA组T淋巴细胞亚群基本恢复正常。结论：连续硬膜外镇痛可减轻非停跳冠状动脉搭桥手术对患者围术期的免疫抑制,有利于患者术后免疫功能的恢复。

Objective To research the effects of continuous epidural analgesia on T-lymphocyte subsets and natural killer cells in patients undergoing off-pump coronary artery bypass.Methods Sixty patients undergoing off-pump coronary artery bypass were randomly divided into group GA（n=30,receiving general anesthesia） and group PCEA（n=30,receiving general anesthesia plus continuous epidural analgesia）.Peripheral blood samples were taken before anesthesia（T0）,4 hours（T1） and on the first（T2）,third（T3）,seventh（T4） day after operation respectively to measure CD3,CD4,CD8,CD4/CD8 and CD16＋56 numbers with flow cytometer.Results The data of two groups obtained before the operation had no difference.The CD3,CD4,CD8,CD4/CD8 and CD16＋56 levels were not significantly different from those before operation in both groups.The CD3,CD4,CD8,CD4/CD8 and CD16＋56 levels decreased significantly at the T1 to T2 in both groups but the decrease was more obvious in group GA on the third postoperative day,the CD3,CD4,CD8,CD4/CD8 and CD16＋56 returned to the preoperative levels in group PCEA and remained low in group GA.Conclusion Continuous epidural analgesia can relieve the immune inhabitation on patients undergoing off-pump coronary artery bypass and make the immune inhabitation recover rapidly.