丙泊酚对肝癌患者围术期免疫功能的影响

Effect of Propofol on Immune Function of Hepatocellular Carcinoma Patients in Perioperative Period

目的探讨丙泊酚麻醉对肝癌患者围手术期免疫功能的影响。方法将86例实施肝癌手术切除术的患者随机分为丙泊酚组(P组,44例)和异氟醚组(S组,42例)。比较2组患者手术前后外周血中T淋巴细胞亚群、NK细胞及IL-6的变化及差异,记录患者实施切除术后的不良反应,并测量患者的体力状况(KPS)评分和体质量。结果 2组患者在实施切除术后外周血中CD3+、CD4+、CD8+、CD4+/CD8+、NK细胞浓度较麻醉前均明显降低,IL-6较麻醉前明显升高,且手术后1 d丙泊酚组NK细胞数量低于异丙醚组且差异具有统计学意义(P<0.05)。丙泊酚组在手术后3 d血清中IL-6浓度恢复至麻醉前水平,而异氟醚组仍高于麻醉前水平。丙泊酚组白细胞下降率(50.0%),低于异氟醚组(61.9%),差异有统计学意义(P<0.05)。2组患者的体力状况(KPS)评分和体质量评分无显著性差异。结论丙泊酚对肝癌患者的免疫功能有明显影响,但白细胞下降率低于异氟醚麻醉,对于白细胞较低的患者适合采用此方法麻醉。

Objective To investigate the effect of propofol anesthesia on immune function of hepatocellular carcinoma patients in perioperative period. Methods 86 patients treated with liver resection surgery were randomly divided into propofol group（ P group,44 cases） and isoflurane group （S group, 42 cases ）. Peripheral blood T lymphocyte subsets, NK ceils and IL-6 changes and differences between the 2 groups before and after surgery were compared, postoperative adverse reactions, KPS score and body weight were recorded. Results Postoperative peripheral blood CD3^＋ , CD4^＋ , CD8^＋ , CD4^＋/CD8^＋, NK cells levels of the 2 groups were significantly lower after resection. Serum IL-6 level was significantly higher than before anesthesia, and postoperative 1 d propofol NK cell numbers was lower than isoflurane group, and the difference was statistically significant（ P 〈 0.05 ）. Serum IL-6 concentration of propofol group 3 d after surgery reached previous level of anesthesia, and isoflurane group was still higher than before anesthesia. Leukopenia of propofol group was 50.0% , and of isoflurane group was 61.9% , the difference was statistically significant （ P 〈 0.05 ）. Conclusion Propofol has significant effect on immune function in patients with liver cancer, but leukopenia is lower than isoflurane anesthesia, this method of anesthesia is suitable for patients with low white blood cell.