不同麻醉方式对肝切除术术后患者免疫功能的影响分析

Analysis of the effect of different anesthesia methods on immune function in patients after liver resection

目的探讨不同麻醉方式对肝切除术术后患者免疫功能的影响。方法选取2013年11月到2015年11月在我科进行开腹左肝手术的患者60例,ASA分级为Ⅰ~Ⅱ级,使用随机数字表法把患者分为静-吸复合麻醉组、全凭静脉麻醉组,每组各30例,使用流式细胞仪对两组的B淋巴细胞、NK细胞、T淋巴细胞亚群(CD3+、CD4+、CD4+/CD8+、CD8+)进行检测,使用ELISA法检测血清中INF-γ、INF-2、INF-2R的含量,分别在麻醉前0.5h(TO)、手术结束时(T1)、术后24 h(T2)时刻进行各项指标检测,并对检测结果进行分析。结果①两组T1、T2时刻的B淋巴细胞数目和T0时刻没有明显变化;②T0时刻,两组的NK细胞、CD3+、CD4+、CD4+/CD8+、CD8+均无统计学差异(P>0.05)。和T0时刻比较,两组的NK细胞、CD3+、CD4+、CD4+/CD8+、CD8+在T1时刻均明显降低(P<0.05),全凭静脉组的CD3+、CD4+、CD4+/CD8+在T2时刻仍明显降低(P<0.05)。组间比较,T2时刻静-吸复合组的CD3+、CD4+、CD4+/CD8+则明显高于全凭静脉组(P<0.05);③T0时刻,静-吸复合组、全凭静脉组的INF-γ、IL-2、sIL-2R均无统计学差异(P>0.05)。T1时刻,两组的INF-γ水平均明显小于TO时刻(P<O.05),T2时刻基本恢复(P>0.05)。T1时刻两组的sIL-2R水平均明显小于T0时刻(P<0.05),T2时刻稍有恢复(P<0.05)。T1、T2时刻,两组的IL-2水平均没有明显变化(P>0.05)。结论静-吸复合麻醉在肝切除术术后患者的细胞免疫恢复上较全凭静脉麻醉快,对免疫功能的影响较小。

Objective To investigate the effect of different anesthetic methods on the immune function of patients after hepa- tectomy. （before anesthesia in the content, and two groups of 60 patients. Methods A total of 2013 November 2015 years 11 months in our department were open left liver surgery patients, ASA grade Ⅰ - Ⅱ, using random number table method were divided into static inhalation combined anesthesia group, total intravenous anesthesia group, each group 30 cases, the use of flow cytometry cytometry B lymphocytes, NK cells and T lymphocyte subsets （CD3 ＋, CD4＋, CD4 ＋/CD8 ＋ , CD8 ＋ ） were detected using ELISA to detect serum interferon gamma INF-2 INF-2R respectively at 0. 5 h T0, the end of operation （T1） and postoperative 24 h （T2） time indicators detection, and the detection results are analyzed. Results There were no significant changes in the number of B lymphocytes and TO moments in the two groups of T1 and T2. The NK cells, CD3 ＋ , CD4＋ , CI）4 ＋/CD8 ＋, CD8 ＋ and were not statistically different （P 〉 0. 05） in the two groups at the time of TO. And TO time comparison, the two groups of NK cells, CD3 ＋ , CD4 ＋, CD4＋/CD8 ＋ , CD8 ＋ in the T1 time was significantly reduced （P 〈0. 05）, the total intravenous group of CD3 ＋ , CD4＋ , CD4 ＋/CD8 ＋ in the T2 time is still significantly reduced （ P 〈 0. 05 ）. Comparison between groups, static time T2-celling of the complex group of CD3 ＋,CD4＋ , CD4＋/CD8 ＋ was significantly higher than that of intravenous group （ P 〈 0. 05 ） ; （3） at the time of TO, static ceiling composite group, by intravenous group of interferon and IL-2, sIL-2R had no statistical difference （ P 〉 0. 05 ）. T1 moments, the two groups of INF- gamma water is significantly less than the average TO time （ P 〈 0. 05 ）, T2 moments of the basic recovery （ P 〉 0. 05 ）. T1 moments of the two groups of sIL-2R levels were significantly less than the TO moments （ P 〈 0.05 ）, T2 moments slightly recovery （P 〈 0.05 ）. T1, T2 moments, the two groups of IL-2 levels were not significantly changed （ P 〉 0.05 ）. Conclusion The immune recovery of patients after liver resection is faster than that of total intravenous anesthesia, and it has less influence on immune function.