局部浸润麻醉和硬膜外麻醉对乳腺良性肿瘤切除患者免疫功能的影响

The effects of local anesthesia and epidural anesthesia on immune function in patients undergoing benign breast tumor surgery

目的比较局部浸润麻醉和硬膜外麻醉对乳腺良性肿瘤切除患者免疫功能的影响。方法将入选的62例行乳腺良性肿瘤切除患者随机分成硬膜外麻醉组和局部浸润麻醉组各31例,分别测定麻醉前(T0)及麻醉后30min(T1)、60min(T2)及90min(T3)的血清T细胞亚群自然杀伤细胞、免疫蛋白浓度以及细胞因子浓度,并对测定结果进行统计学比较。结果硬膜外麻醉组在T1时的lgG、lgA及lgM水平均较T0明显降低(P<0.05),且在T1时硬膜外麻醉组的lgG、lgA及lgM水平也均较局部浸润麻醉组明显降低(P<0.05);硬膜外麻醉组的lgA在T2和T3时点均较T0时点明显降低(P<0.05)。在T1和T2时点,硬膜外麻醉组的CD4+(%)和NK细胞(%)与同组T0时点比较,差异均有统计学意义(P<0.05);在T3时点,局部浸润麻醉组的IL-12、IFN-γ及TNF-α水平均较同组T0点比较,差异均有统计学意义(P<0.05);在T2时点,局部浸润麻醉组的TNF-α水平与同组T0时点比较,差异亦有统计学意义(P<0.05)。结论局部浸润麻醉对乳腺良性肿瘤患者围手术期的免疫功能影响较小,是乳腺良性肿瘤患者围手术期较好的一种麻醉方法。

Objective To investigate the effects of local anesthesia and epidural anesthesia on immune function in patients undergoing benign breast tumor surgery. Methods 62 patients undergoing benign breast tumor surgery were se- leered and divided into two groups, local anesthesia group（n= 31）, epidural anesthesia group（n= 31）. Peripheral vein blood was obtained before anaesthesia（T1）,at 30 rain（T2）,60 min （T3）and 90 min（T4）during anaesthesia for detecting CD3＋ ,CD4＋ ,CD8＋ ,and natural killer cells by flow eytometry, IL-12, IFN-T, IL-4, TNF-a by ELISA, IgG, lgA, lgM by immunodiffusion. Results In epidural anesthesia group, the level of lgG,lgA and lgM at T1 reduced compared with those at T0（P〈0. 05）. There were significant different in the level of lgG,lgA and lgM at T1 between two groups（P〈 0. 05）. In epidural anesthesia group,at T2 and T3 ,CD4＋ increased and natural killer cells decreased significantly compared with those at TI（P〈0.05）. In local anesthesia group, the level of IL-12,IFN-7 and TNF-α at T3 increased compared with those at T0（P〈0.05）. There were significant different in the ~,evel of IL-12 ,IFN-γand TNF-α at T3 between two groups（P〈0. 05）. Meanwhile, there were significant different in the level of TNF-α at T2 between two groups（P〈0.05）.Conclusion This study indicates that local anesthesia has less effects on immune function than that of epidural anesthesia in patients undergoing benign breast tumor surgery.