两种麻醉方法对原发性肝癌围手术期免疫学指标的影响

Comparison of effects of two anesthetic approaches on infections of immunol-ogical parameters during splenectomy in hepatocellular carcinoma

目的:探讨两种麻醉方法对原发性肝癌患者围手术期免疫学相关指标的影响。方法:选择原发性肝癌患者60例,肝功能Child-Pugh分级为A^B级,随机分为两组,异丙酚全凭静脉麻醉组30例(A组),七氟醚静吸复合麻醉组30例(B组),分别记录麻醉前30 min(T0)、术毕(T1)、术后24 h(T2)静脉血中CD3^+、CD4^+、CD8^+、CD4^+/CD8^+及TNF-α、IL-2、IL-6的水平。结果:A、B两组患者围手术期生理指标MAP、HR、SpO_2、RR各时点均无明显差异(P>0.05);麻醉前A、B两组CD3^+、CD4^+、CD8^+、CD4^+/CD8^+均无显著性变化(P>0.05),两组CD3^+、CD8^+在各时点均未发生显著性变化(P>0.05)。与T0相比,T1时点A、B两组CD4^+、CD4^+/CD8^+均降低(P<0.05),但B组T2时点与T0时点比较无显著性差异。在T1、T2时点B组CD4^+、CD4^+/CD8^+均比A组明显升高(P<0.05)。与T0时点相比,A组和B组患者在T1、T2时点IL-6水平明显升高(P<0.05),各时点A组和B组间差异无统计学意义(P>0.05)。与T0时点相比,A组TNF-α水平无显著变化(P>0.05),B组术后一天明显升高(P<0.05)。IL-2在各时点两组间均无显著性变化(P>0.05)。结论:异丙酚全凭静脉麻醉和七氟醚静吸复合麻醉均会对肝癌患者的免疫功能产生抑制作用,使用七氟醚静吸复合麻醉组对患者免疫功能影响较小。

Objective： To investigate the impacts of two anesthesia approaches on infections of immunological parameters during splenectomy in hepatocellular carcinoma patients. Methods： Sixty hepatocellular carcinoma patients were divided into two groups randomly,each groups was thirty（ liver function Child-Pugh grade was A-B）. Total intravenous anesthesia with pmpofol group（ group A,n = 30） and combined intravenous inhalational anesthesia with sevoflurane group（ group B,n = 30）. Before induction of anesthesia,at the end of operation,and after operation 24 hours. blood samples were collected to determined with the level of CD3^＋,CD4^＋,CD8^＋,CD4^＋/ CD8^＋and TNF-α,IL-2,IL-6 of hepatocellular carcinoma patients. Results： The perioperative physiological index MAP,HR,SpO_2,RR each point had no obvious difference between two groups（ P〈0. 05）. The levels of CD3^＋,CD4^＋,CD8^＋,CD4^＋/ CD8^＋had no significant difference between two groups before anesthesia（ P〈0. 05）. There was no significant changes in CD3^＋,CD8^＋with two groups in all moments. Compared with the T0,A,B two groups of CD4^＋,CD4^＋/ CD8^＋were lower（ P〈0. 05） in T1 point,but T2 point and T0 point had no significant difference in group B. The levels of CD4^＋,CD4^＋/ CD8^＋in group B were higher than in group A（ P〈0. 05）.Compared with T0 moment,group A and group B patients postoperative IL- 6 in T1,T2 level increased significantly（ P〈0. 05）,and there was no statistically significant difference between group A and group B in all moment.（ P〈0. 05）. Compared with the T0 moment,there was no significant change in group A of TNF-α level（ P〈0. 05）,while group B increased significantly in postoperative day（ P〈0. 05）. The level of IL-2 in each moment interval between the two groups had no significant difference（ P〈0. 05）. Conclusion：Both total intravenous anesthesia with pmpofol and combined intravenous inhalational anesthesia with sevoflurane inhibit the immune function of the patients with hepatocellular carcinoma cell immune reaction. The inhibitory effect of sevoflurane inhalation anesthesia on cell immune function is less affected.