丙泊酚靶控输注清醒镇静对患者围术期T细胞亚群及NK细胞的影响

Effects of conscious sedation with propofol target controlled infusion on perioperative T cell-subgroups and NK cells of the patients

目的观察丙泊酚靶控输注(TCI)清醒镇静对围术期患者T细胞亚群及NK细胞的影响。方法 30例硬膜外麻醉下行子宫切除或下肢手术的患者,ASAⅠ或Ⅱ级,随机均分为对照组和丙泊酚TCI组(TCI组)。手术前5min开始输注生理盐水或丙泊酚,手术结束前5min停止输注。流式细胞术测定输注开始(T1)、手术开始(T2)、术毕(T3)、术后24h(T4)和术后48h(T5)各时点外周静脉血T细胞亚群和NK细胞水平。结果与T1时比较,T2～T5时对照组CD3+、CD4+、(CD3++CD4+)/(CD3++CD8+)和NK细胞明显降低(P<0.05或P<0.01),T3、T4时TCI组CD3+、CD4+、(CD3++CD4+)/(CD3++CD8+)和T2～T4时NK细胞明显降低(P<0.05)。T2～T5时对照组CD3+、CD4+、(CD3++CD4+)/(CD3++CD8+)及NK细胞变化幅度大于TCI组。两组各时点CD8+差异无统计学意义。结论硬膜外麻醉复合丙泊酚TCI清醒镇静可改善患者围术期免疫功能。

Objective To investigate the effects of conscious sedation with propofol target controlled infusion （TCI） on perioperative T cell-subgroups and NK cells of the patients. Methods Thirty patients undergoing hysterectomy or lower extremity surgery with epidural anesthesia, ASA class I or Ⅱ were equally randomized to group control and group propofol TCI （group TCI）. Propofol or saline was infused from 5 minutes before the start of operation, to 5 minutes before the end of operation. T cell-subgroups and NK cells were measured by flow cytometry before sedation （T1）, at the start of operation （T2）, at the end of operation （T3）, 24 h after operation （T4） and 48 h after operation （T5）. Results Compared with TI, CD3 ＋, CD4＋, （CD32-2-CD4＋）/（CD3＋＋CD8＋） and NK cells decreased at T2 -T5 in group control （P 〈0. 05 or P〈0.01 ）. CD3＋, CD4＋ and （CD3 ＋ ＋ CD4 ＋ ） / （ CD3 ＋ 2- CD8＋ ） decreased at T3 and T4, and NK ceils decreased at T2-T4 in group TCI （P〈0. 05）. The oalues of CD3＋, CD4＋, （CD3＋＋CD4＋）/ （CD3＋＋CD8＋） and amplitude of vari＇ation of NK cells in group control at T2-T5 were higher that those in group TCI. There was no significant difference with regard to CD8 2_ between the two groups. Conclusion Epidural anesthesia combined with conscious sedation with propofol TCI may ameliarate the immune function of perioperative patients.