不同麻醉方法对胆道手术患者免疫功能的影响

Effects of different anesthesia methods on immune function of patients with biliary tract surgery

目的 探讨不同麻醉方法对胆道手术患者免疫功能的影响.方法 64例ASA Ⅰ-Ⅱ级择期行胆道手术患者随机分为硬膜外麻醉组（硬麻组）和全身麻醉组（全麻组）各32例,观察两组T细胞亚群和自然杀伤（NK）细胞的变化.结果 两组麻醉后2h、术后1d、3d与麻醉前比较,CD3＋、CD4＋、CD4＋/CD8＋及NK细胞水平均明显下降（P〈0.05）,全麻组术后5d与麻醉前比较,CD3＋、CD4＋、CD4＋/CD8＋及NK细胞水平均明显下降（P〈0.05）;术后1d、3d、5d,全麻组与硬麻组比较,CD3＋、CD4＋细胞水平均明显下降（P〈0.05）,术后1d,全麻组与硬麻组比较,CD4＋/CD8＋及NK细胞水平均明显下降（P〈0.05）.结论麻醉对胆道手术患者免疫功能有一过性不同程度的抑制,其中全身麻醉较硬膜外麻醉更为明显.

Objective To observe the effects of different anesthesia methods on immune function of patients with biliary tract surgery in patients.Methods 64 patients with ASA Ⅰ～Ⅱ grade elective biliary tract surgery were randomly divided into general anesthesia group （n= 32） and epidural anesthesia group（n = 32） respectively.The changes of T cell subsets and natural killer（NK） cells were observed.Results The levels of CD3＋ 、CD4＋、 CD4＋、CD8＋ and NK cells after anesthesia 2h,postoperation 1d and 3d were significantly lower than those before anesthesia in two groups（P〈0.05） .general anesthesia group after surgery 5d were significantly lower than those before anesthesia（P〈0.05） ;After surgery 1d,3d and 5d,general anesthesia group was significantly lower than epidural anesthesia group （P〈0.05） ;The levels of CD3＋、CD4＋ in general anesthesia group was significantly lower than epidural anesthesia group（P〈0.05） ,after surgery 1 d,the levels of CD4＋、 CD8＋ and NK cells in epidural anesthesia group were significantly lower than those in general anesthesia group（P〈0.05）.Conclusion Anesthesia had an inhibition of transient varying degrees for the immune function of patients uaderwent biliary tract surgery,which general anesthesia was more evident than epidural anesthesia.