围术期保温对老年病人免疫功能的影响

Effects of perioperative heat preservation on the immune function in elderly patients

目的探讨研究围术期保温对老年病人的免疫功能的影响。方法选择60例腹腔镜下行直肠癌根治术老年病人,ASAⅠ～Ⅱ级,随机分为两组,每组30例,Ⅰ组为对照组,按常规手术进行,Ⅱ组为实验组,采用综合性保温。分别监测和记录两组患者在麻醉前及麻醉后30、60、90、120min和术毕的鼻咽温度。麻醉前,术毕24、48、72、120、168h取外周静脉血测量两组老年病人的T细胞(CD3+、CD4+、CD8+)、NK、IL-2、IL-6、TNF-α、C3、C4和CRP的含量。结果Ⅰ组麻醉后30、60、90、120min及术毕时体温明显低于麻醉前和Ⅱ组体温(P<0.05或P<0.01)。两组患者在术后24、48、72h时CD3+、CD4+、NK和IL-2含量较麻醉前均下降(P<0.05或P<0.01),但Ⅱ组的CD3+、CD4+、NK和IL-2水平明显高于Ⅰ组的(P<0.05)。两组的IL-6、TNF-α、C3、C4和CRP的含量较麻醉前明显升高(P<0.05或P<0.01),但Ⅱ组的IL-6、TNF-α、C3、C4和CRP的含量明显低于Ⅰ组水平(P<0.01),在术后120h时,Ⅰ组的CRP的含量明显高于Ⅱ组和麻醉前水平(P<0.01)。结论围术期综合性保温能够部分减轻老年患者术后免疫抑制程度,使患者早期康复。

We aim to research the effects of perioperative heat preservation on the immune function in elderly patients. Total of 60 elderly patients undergone the laparoscopic rectal cancer resection,with ASAⅠ-Ⅱ,were randomly and averagely divided into two groups,Control group （groupⅠ） was operated according to conventional surgery,while experimental group （groupⅡ） was put in comprehensively heat preservation. We monitored and recorded respectively the nose pharynx temperature of each group patients in preanesthesia,30,60,90,120 minutes post-anesthesia and post-operation; peripheral blood was drew to measure T cells （CD3＋,CD4＋,CD8＋）,NK,IL-2,IL-6,TNF-α,C3,C4 and CRP levels before anesthesia and at 24,48,72,120,168 hours after operation. The temperature at 30,60,90,120 minutes after anesthesia and post-operation in groupⅠwas lower than that of pre-anesthesia and groupⅡ （P 0.05,P 0.01）; the levels of CD3＋,CD4＋,NK and IL-2 at 24,48,72 hours after operations in two groups were significantly lower that of than pre-anesthesia （P 0.05,P 0.01）,but groupⅡwas significantly higher than groupⅠ（P 0.05）. The levels of IL-6,TNF-α,C3,C4 and CRP in two groups were distinctly higher than those of pre-anesthesia （P 0.05,P 0.01）,but groupⅡwas significantly lower than groupⅠ （P 0.05） at 24,48,72 hours after operations. The levels of CRP at 120 hours after operations in groupⅠwere clearly higher than that in groupⅡand pre-anesthesia （P 0.01）. We conclude that the perioperative comprehensive heat preservation can partly alleviate immunosuppression in elderly patients after operations and make them early recovery.