不同全麻方法对舌癌根治术患者T淋巴细胞亚群的影响

Effects of Different General Anesthesia Methods on T Lymphocyte Subsets in Patients Undergoing Radical Operation for Tongue Cancer

目的：评价不同全麻方法对舌癌根治术患者外周血T淋巴细胞亚群的影响。方法：择期舌癌根治术患者45例，ASA分级Ⅰ或Ⅱ级，根据全麻方法分为：T组（全凭静脉麻醉），C组（静吸复合麻醉），Ⅰ组（吸人麻醉）。3组患者术后均行静脉自控镇痛，视觉模拟评分法评价患者疼痛程度。于麻醉诱导前30min（T0）、麻醉后ih（TI）、3h（T2）、5h（T3）、手术结束时（T4）、手术结束后24h（T5）、48h（T6）、72h（T7）时采集外周静脉血，采用流式细胞仪测定外周血T淋巴细胞亚群（CD3＋、CD4＋、CD8＋）百分比，计算CD4＋／CD8＋比值。结果：3组患者一般情况、手术时间、出血量、术后VAs评分差异无统计学意义。与TO比较，3组患者TI～5时CD3＋、CD4＋百分比、CD4＋／CD8＋。比值显著降低，c组和Ⅰ组患者T6时CD3＋、CD4＋百分比、CD4＋／CD8＋比值亦低于TO水平（P〈O．05）；C组在T2～3的CD4＋、CD4＋／CD8＋比值显著低于T组（P〈0．05），且其在T4～5的CD4＋、CD4＋／CD8＋比值显著高于Ⅰ组（P〈0．05）。Ⅰ组在T2～6的CD3＋、CD4＋、CD4＋／CD8＋。比值显著低于T组（P〈0．05），各组患者T1～7的CD8＋ 百分比与T0相比，差异无统计学意义。结论：以异丙酚、瑞芬太尼为主的全凭静脉麻醉对舌癌根治术患者外周血T淋巴细胞亚群抑制程度低，有利于维持细胞免疫功能。

Objective： To investigate the effects of different general anesthesia methods on circulating T lympho- cyte subsets in patients undergoing radical operation for tongue cancer. Methods： 45 ASA I or II patients undergoing elective radical operation for tongue cancer were randomized to 3 groups （n=15 each） ： T group received total intra- venous anesthesia; C group received combined intravenous-inhalational anesthesia and I group received inhalational anesthesia. Visual analogue scores（VAS） were used to evaluate the degree of postoperative pain. Peripheral venous blood samples were taken at 30 min before （T0） and 1 h （T1）, 3 h （T2） and 5 h （T3） after induction of anesthesia, the end of operation （T4） and at 24h （T5）, 48 h （T6） and 72 h （TT） after operation for determination of the per- centages of T lymphocyte subsets （CD3 ＋, CD4 ＋, CD8 ＋, CD4 ＋ / CD8 ＋ ） with flow cytometer. Results： The percentages of CD3＋, CD4＋, and CD4＋/ CD8＋ ratio were significantly decreased during and after operation at T1--5 and also at T6 in C group and I group （P〈0.05）. The percentage of CD4＋ cells and CD4＋/ CD8＋ ratio were significantly lower during anesthesia at T2-3 in C group than in T group（P〈0.05）. The percentages of CD3 ＋, CD4＋, and CD4＋/ CD8＋ ratio were significantly lower at T2-6 in I group than in T group（P〈0.05）. The percentage of CD4＋ and CD4＋/CD8＋ ratio were significantly higher after operation at T4, 5 in C group than in I group（P〈0.05）. Conclusion： TIVA with propofol and remifentanil has less impact on circulating T lymphocyte subsets than inhalational and combined intravenous inhalational anesthesia in patients undergoing radical operation for tongue cancer.