硬膜外阻滞对老年腹腔镜胃癌根治术患者围术期Th_1/Th_2平衡的影响

Th_1/Th_2 balance in elderly patients undergoing laparoscopic radical operation for gastric cancer under general anesthesia plus epidural block

目的研究硬膜外阻滞对腹腔镜胃癌根治术老年患者围术期Th_1/Th_2平衡的影响。方法对60例择期行腹腔镜胃癌根治术老年患者采用随机数字表法分为硬膜外阻滞组(Ⅰ组)和对照组(Ⅱ组),每组30例。麻醉诱导前行T_(8-9)间隙行硬膜外穿刺置管。Ⅰ组切皮前约30min时硬膜外腔注射0.25%罗哌卡因+0.04mg/ml布托啡诺混合液10ml。Ⅱ组给予等量0.9%氯化钠溶液。两组患者均在术毕硬膜外腔注射0.25%罗哌卡因+0.04 mg/ml布托啡诺混合液10ml后接PCEA泵。于硬膜外穿刺前(T_0)、术前(T_1)、术毕(T_2)、术后24h(T_3)和72 h(T_4)抽取外周血,采用放射免疫法检测血浆皮质醇(Cor)水平,采用ELISA法测定血浆干扰素(IFN)-γ、IL-4水平。结果与T_0时比较,Ⅱ组T_2、T_3时Cor水平升高,Ⅰ组仅在T_2时升高(P<0.05)。与Ⅱ组比较,Ⅰ组T_2、T_3时Cor水平明显降低(P<0.05)。与T_0比较,两组T_2、T_3、T_4时IFN-γ水平明显上升(P<0.05)。Ⅰ组T_2、T_3时IFN-γ水平明显高于Ⅱ组(P<0.05)。Ⅰ组T_3时IL-4水平低于T_0(P<0.05)。与Ⅱ组比较,Ⅰ组T_4时IL-4水平明显降低(P<0.05)。与T_0时比较,两组T_2、T_3、T_4时IFN-γ/IL-4均升高(P<0.05);Ⅰ组T3时IFN-γ/IL-4明显高于ⅡI组(P<0.05)。结论硬膜外阻滞能减轻腹腔镜胃癌根治术老年患者手术后Th_1/Th_2平衡的漂移程度,改善机体手术创伤后免疫受抑状态。

Objective To determine Th1/Th2 balance in elderly patients undergoing laparoscopic radical operation for gastric cancer under general anesthesia plus epidural block. Methods Sixty ASA physical Ⅰor Ⅱ patients aged 65-75 y scheduled for elective laparoscopic radical operation for gastric cancer under general anesthesia, were randomly divided into epidural block group （group Ⅰ,n=30） and control group （group Ⅱ, n=30）. The epidural catheter was placed at T0-9 interspace before induction of anesthesia. In group Ⅰ, 10 ml of mixture of 0.25% ropivacaine and 0.04mg/ml butorphanol was injected via the epidural catheter at 30 rain before skin incision; the same volume of normal saline was given in group Ⅱ. The mixture 10 ml 0.25% ropiva- caine and 0.04mg/ml butorphanol was administered via the epidural catheter at 10 min before the end of operation followed by patient-controlled epidural analgesia in both groups. Plasma cortisol levels were detected by radioimmunoassay, interferon-γ （INF- γ ） and interleukin-4 （IL-4） were measured by ELISA before induction of anesthesia （T0）, at the begin of operation （T1）, at the end of operation （To）, at 24h （T3） and 72h （T4） after operation. Results Compared with To, plasma cortisol levels were higher at T0 and T3 in group Ⅱ and at T3 in group Ⅰ （P〈0.05）. Cortisol levels at T2 and T3 were lower in group Ⅰ than those in group Ⅱ （P〈 0.05）. IL-4 level in group Ⅰ was lower at T3 than that at To （P〈0.05）. IL-4 at T4 was lower in group Ⅰ than that in group Ⅱ （P〈0.05）. INF- γ in group Ⅰ was higher at T2 than that at To （P〈0.05）, which was higher at T3 than that of group Ⅱ （P〈0.05）.The ratio of IFN- γ/IL-4 in both groups was significantly higher at T0, T3 and T4 than that at T0, and the ratio of IFN- γ/IL-4 at T3 in group Ⅰ was higher than that in group Ⅱ（P〈0.05）. Conclusion Epidural block may alleviate immunological suppression in elderly patients undergoing gastric radical surgery under general anesthesia.