人工建立褪黑素节律对妇科手术病人术后细胞免疫功能的影响

Effect of artificial circadian rhythm of melatonin on postoperative cellular immune function in patients un- dergoing gynecological operation

目的评价人工建立褪黑素节律对妇科手术病人术后细胞免疫功能的影响。方法择期行妇科手术病人18例，年龄25～50岁，体重45—80kg，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将其随机分为3组（n=6）：正常对照组（C组）、安慰剂对照组（P组）和褪黑素组（M组）。分别于术前1d、手术当天和术后1d21：00熄灯前10min时，M组口服褪黑素6mg，P组口服安慰剂。术中采用连续硬膜外麻醉，术后采用病人自控硬膜外镇痛，维持VAS评分〈5分。分别于术前1d（基础状态）、术毕及术后1d时采集外周静脉血样，采用流式细胞术测定CD4＋、CD8＋、CD3＋细胞数，并计算CD4＋与CD8＋细胞数的比值。结果c组、P组和M组间CD4＋、CD8＋、CD3＋细胞数及CD4＋与CD8＋细胞数的比值差异无统计学意义（P〉0．05）。结论人工建立褪黑素节律对妇科手术病人术后细胞免疫功能无明显影响。

Objective To investigate the effect of artificial circadian rhythm of melatonin on the postoper- ative cellular immune function in patients undergoing gynecological operation. Methods Eighteen ASA Ⅰor Ⅱ patients, aged 25-50 yr, weighing 45-80 kg, scheduled for elective gynecological operation, were randomly divided into 3 groups （ n = 6 each） ： control group （ group C ）, placebo control group （ group P） and melatonin group （group M）. In group M, melatonin 6 mg was given orally at 10 min before lights-out （21：00） on 1 day before op- eration, on the day of operation and on 1 day after operation, while placebo was given orally instead of melatonin in group P. The operation was performed under epidural anesthesia. Patient-controlled epidural analgesia with ropiva- caine was used for postoperative analgesia. VAS score was maintained 〈 5. BloOd samples were collected from the peripheral vein at 1 day before operation （ baseline）, the end of operation and 1 day after operation to measure CD4＋ , CD8＋ and CD3＋ cell count by flow cytometry. The ratio of the number of CD4＋ cells to the number of CD8＋ cells was calculated. Results There were no significant differences in the number of CD4＋ , CD8＋ and CD3＋ cells and ratio of the number of CD4＋ cells to the number of CD8 ＋ cells between groups C, P and M （ P 〉 0.05）. Conclusion Artificial circadian rhythm of melatonin exerts no influence on the postoperative cellular im- mune function in patients undergoing gynecological operation.