黄芪注射液对腹腔镜手术患者围术期NK细胞水平的影响

Effect of astragalus injection on perioperative natural killer cell levels in patients undergoing laparoscopic surgery

目的探讨黄芪注射液对腹腔镜手术患者围术期NK细胞水平的影响。方法选择40例择期全麻下行腹腔镜手术患者，年龄20～50岁，ASA分级Ⅰ-Ⅱ级，无血液病和免疫、内分泌系统等疾病，将其随机分成黄芪注射液组（A组）和对照组（C组）。A组静滴黄芪注射液10ml＋生理盐水90ml，15min滴完后静注芬太尼、丙泊酚、艾可松行气管插管控制呼吸，术中以丙泊酚及七氟醚维持麻醉，维持生命征在正常水平，术毕前腹腔冲洗液加入黄芪注射液10ml，术毕待病人自主呼吸恢复，清醒后拔管。C组静滴生理盐水100ml后麻醉，腹腔冲洗液中不加黄芪注射液，余同A组。采集手术前（TO）、术毕（T1）、术后1d（T2）、术后3d（T3）的静脉血，流式细胞仪测定NK细胞（CD16＋56）的水平。结果C组NK细胞水平在T0、T1、T2、T3时分别为（18±7）％、（29±9）％、（17±7）％、（11±5）％；A组NK细胞水平在T0、T1、T2、T3时分另0为（16±5）％、（28±8）％、（22±7）％、（15±4）％。与T0时比较，C组NK细胞水平T1时明显升高，T2时下降至T0时水平，T3明显下降，A组T1、T2时均明显升高，至T3时仍在T0时水平，在T2、T3时A组明显高于C组（P〈0．05）。结论C组术后NK细胞水平相对A组抑制明显，表明黄芪注射液在腹腔镜手术的应用对患者细胞免疫具有一定的保护作用。

Objective To explore the effect of astragalus injection on perioperative natural killer cell （ NKC ） levels in patients undergoing laparoscopic surgery. Methods Forty ASA Ⅰ-Ⅱ patients scheduled for laparoscopic surgery who had no any diseases of blood, endocrine and immune system were randomly divided into study group and control group. The study group received astragalus injection of 10 ml plus NS of 90 ml for 15 rain, then induction with fentanyl, propofol, and rocuronium for tracheal intubation, and propofol and sevoflurane for anesthetic maintenance, and then intra-abdominal washing with astragalus injection of 10 ml before the end of surgery; the control group received no astragalus injection before induction and the end of surgery. Venous blood samples were collected for detecting NKC （ CD16±56 ） levels before surgery （ TO ）, at completion of surgery （ T1 ）, and on days 1（ T2 ） and 3 （ T3 ） after surgery. Results In the control group, NKC levels were obviously increased at T1, declined back to the baseline levels at T2, and decreased markedly at T3; while in the study group NKC levels elevated obviously at T1 and T2, and maintained at the baseline levels at T3. Levels of NKC were obviously higher in the study group than in the control group at T2 and T3. Conclusions Afte surgery, NKC levels are significantly inhibited in the control group as compared with the study group, suggesting that astragalns injection plays a certain role in the protection of cellular immunity in patients undergoing laparoscopic surgery.