不同剂量乌司他丁对腹腔镜结直肠癌手术患者细胞免疫和肝肾功能的影响

Effects of ulinastatin on cellular immunity and hepatorenal functions in patients with laparoscopic surgery for colorectal cancer

目的探讨不同剂量乌司他丁对腹腔镜结直肠癌患者手术细胞免疫和肝肾功能的影响。方法选择行腹腔镜结直肠癌根治术患者60例,年龄32～78岁,体重42～77 kg,ASAⅠ～Ⅱ级,分为4组(n=15),分别于全麻诱导前静脉泵注乌司他丁0.5×104U/kg(Ⅰ组)、1.0×104U/kg(Ⅱ组)、1.5×104U/kg(Ⅲ组)和等量生理盐水(C组)。麻醉诱导前(T0)和术后第1(T1)、3(T2)、5(T3)、7(T4)天采静脉血检测T细胞亚群(CD3+、CD4+、CD8+和CD4+/CD8+)、肝功能(AST和ALT)和肾功能(BUN和Cr)。结果 T0时4组T细胞亚群各指标比较差异均无统计学意义(P>0.05)。与T0比较,T1时4组T细胞亚群各指标均降低,其中C组CD3+、CD4+,Ⅰ、Ⅱ、Ⅲ组CD4+均明显下降(P<0.05);C组T2时CD3+、CD4+和CD4+/CD8+仍较T0明显下降(P<0.05),Ⅰ、Ⅱ、Ⅲ组T2时CD3+、CD4+和CD4+/CD8+均回升至T0水平。与C组比较,Ⅰ、Ⅱ组T2时CD3+、CD4+和T3时CD4+,Ⅲ组T2、T3时CD3+、CD4+和CD4+/CD8+均明显高于同时间点C组(P<0.05)。Ⅰ、Ⅱ、Ⅲ组CD3+、CD4+、CD4+/CD8+同时间点组间比较,4组间CD8+、AST、ALT、BUN和Cr比较,差异均无统计学意义(P>0.05)。结论腹腔镜结直肠癌手术可明显降低患者细胞免疫功能,以术后第1～3天最明显。不同剂量乌司他丁均能改善术后细胞免疫功能,以1.5×104U/kg较好,对肝肾功能均无明显影响。

Objective To investigate the effects of ulinastatin on cellular immunity and hepatorenal functions in patients with laparoscopic surgery for colorectal cancer. Methods Sixty patients with laparoscopic eolorectal cancer surgery （ASA I or Ⅱ , aged 32 ~ 78 year, weighing 42 -77 kg） , were divided into Group I , Ⅱ , Ⅲ and Group C. Before anesthesia induction, ulinastatin of 0. 5 × 104, 1.0 × 104 and 1.5 x l04 U/kg, and the replaced saline were given to the subjects in Group I , Ⅱ ,ⅡI and C, respectively. Venous blood samples were collected for assessment of T - lymphocyte subsets （CD3 ＋, CIM＋, CD8＋ and CIM＋/CD8 ＋）, liver function （AST and ALT） and renal function （BUN and Cr） before anesthesia induction（T0）, on the first day （T1）, the third day（T2）, the fifth day （T3） and the seventh day （T4）. Results No significant difference was revealed in CD3 ＋ , CD4 ＋ , CD8 ＋ or CD4 ＋/CD8 ＋ among the four groups at TO （P〉0.05）. Compared to TO, CD3 ＋ andCD4 ＋ in Group C, CD4 ＋ in Group ~ , Ⅱ and Ⅲ at T1, and CD3 ＋, CD4~ and CD4＋/CD8＋ in Group C at T2 were significantly reduced （P 〈0. 05）. However, CD3＋ , CD4＋ and CIM＋/ CD8 ＋ were significantly reversed at T2 in Group I , Ⅱ and Ⅲ. CD3 ＋ at T2, and CD4 ＋ at T2 and 33 in Group I and Ⅱ ; CD3 ＋ , CD4 ＋ and CIM ＋/CD8 ＋ at T2 and 33 in Group m were significantly higher than those in Group C （ P 〈 0. 05 ）. There was no significant difference in CD3 ＋ , CD4 ＋ , or CD4 ＋/CD8 ＋ among Group I , Ⅱ, Ⅲ ; neither was in CD8 ＋ , AST, ALT, BUN or Cr among the four groups （ P 〉 0.05 ）. Conclusion The cellular immune function is reduced 1 ～ 3 days after laparoscopic surgery for colorectal cancer, which can be alleviated by ulinastatin （ most effective in 1.5 ～ 104 U/kg） with no effect on hepatorenal functions.