全麻与硬膜外阻滞复合全麻对开胸手术患者围术期T细胞亚群的影响

The effects of combined general-epidural anaesthesia on perioperative immune response in patients undergoing thoracic surgery

目的 研究全麻与硬膜外阻滞复合全麻对开胸手术患者围术期T细胞、T辅助细胞和白细胞介素 10 (IL 10 )的影响。方法 选择择期开胸手术病人 30例 ,随机分为两组。对照组 (全麻组 ) :地西泮、芬太尼、丙泊酚、维库溴铵诱导 ,芬太尼、丙泊酚、维库溴铵、安氟醚维持 ;观察组 (复合组 ) :全麻方法同上 ;术前术中硬膜外持续输利多卡因、芬太尼混合液。两组于麻醉前 (T1)、切皮后 2小时 (T2 )和术后 2 4小时 (T3 )、48小时 (T4 )测外周血CD3 、CD4 、CD8、CD2 3 + B细胞及单核细胞HLA DR表达和IL 10变化。同时测定外周血肾上腺素 (E)、去甲肾上腺素 (NE)。结果 对照组切皮后 2小时CD3 细胞下降 ,术后 2 4小时CD4 细胞和CD4 /CD8比值降低 ,试验组切皮后 2小时CD4 /CD8升高。两组术后 2 4小时CD2 3 + B细胞和IL 10均显著升高 ,单核细胞HLA DR表达下降。复合组在术中、术后NE值均显著低于对照组。结论 硬膜外阻滞加全麻能够较好地抑制手术应激反应 ,抑制术后CD3 、CD4

Objective To observe the effects of combined general-epidural anesthesia on perioperative T cell,T helper cell function and interleukin-10 response.Methods Thirty patients were randomly assigned into two groups.General anaesthesia group (group G):anaestheisa was induced with diazepam,fentanly,propofol and vecuronium and mentained with fentanly,propofol and vecuronium as well as enflurane inhalation.Combined anesthesia group(group C):General anesthesia was used as in group G and continous epidural block with 1.5% lidocaine and 5μg/ml fentanyl was added during operation.Peripheral blood CD 3,CD 4,CD 8,CD 23 +B and HLA-DR on monocyte ,and IL-10 were measured before induction of anesthesia (T1),2h after incision (T 2),24h (T 3)an 48h (T 4) after completian of the surgery peripheral blood epinephrinece,and Norepinephrine(NE) were observed in the same time. Results CD 3% decreased at T 2 and CD 4%,CD 4/CD 8 ratio decreased at T 3 in the group C,but not in the group G.CD 4/CD 8 ration increased at T 2 in group C.CD 23 +B% lymphocyte increased and fluorescene of HLA-DR expression on monocyte decreased significantly in both groups.Plasma level of IL-10 increased significantly at T 3.There was no significant difference between the two groups.Blood NE level in group C was signiticantly lower than in group G during and after operation. Conclusion Epidural block combined with general anesthesia has a better inhibition effect on stress response to surgery and may prevent the decreases of CD 3% and CD 4% in peripheral blood after operation.