全身麻醉患者围手术期外周血白细胞源性及血浆β-内啡肽含量变化

The changes of β-endorphin level in the peripheral leukocytes and plasma of patients under general anesthesia during perioperative period

目的研究全身麻醉下患者围手术期外周血白细胞数量和白细胞源性及血浆β-内啡肽（β-endorphin，β-EP）含量变化。方法选取48例年龄24～65岁，ASA分级Ⅰ、Ⅱ级患者，静脉全身麻醉下行择期手术。记录围手术期外周血白细胞总数及分类计数。于麻醉开始前（T1）、麻醉结束患者清醒后（T2）采集肘静脉血4ml，流式细胞术检测白细胞中β-EP荧光阳性细胞百分数和平均荧光强度（mean fluorescence intensity，MFI），放射免疫分析法测定血浆β-EP水平。结果T2白细胞总数[（10．80±3．39）×10^9／E]高于T1[（5．55±1．64）×10^9／L]（P〈0．01），T2粒细胞[（8．82±3．10）×10^9／L]显著高于T1[（3．27±1．32）×10^9／L]，增高最为明显；L单核细胞计数[（0．64±0．38）×10^9／L]高于T1[（0．43±0．18）×10^9／L]（P〈0．01），而T2淋巴细胞数量[（1．29±0．47）×10^9]低于T1[（1．73±0．56）×10^9]（P〈0．01）。T2各类白细胞中B-EP的MFI均较T1降低（P〈0．05），血浆β-EP水平亦显著下降（P〈0．01）。结论围手术期全身麻醉患者外周血白细胞总数增加，以粒细胞增高为主，而白细胞内和血浆β-EP水平均降低；细胞数量和β-EP水平的改变与围手术期镇痛及机体应激反应有关。

Objective To investigate the changes of the number of peripheral leukocytes as well as β-endorphin（β-EP） level in the peripheral leukocytes and plasma of patients under general anesthesia during perioperative period. Methods A total of 48 ASA Ⅰ-Ⅱ patients aging from 24 to 65 years old who were under general intravenous anesthesia for scheduled surgery were enrolled into the current study. The total number and types of peripheral leukocytes were determined during perioperative period. The peripheral blood was collected before （T1） and after anesthesia （T2）. Flow cytometry was used to measure the percentage and mean fluorescence intensity （MFI） of leukocytes with fluorescent positive β-EP. The level of plasma β-EP was measured by radioimmunoassay. Results The total number of leukocytes at T2[（10.80±3.39）×10^9/L] was significantly higher than that at T1[（5.55± 1.64）×10^9/L]（P〈0.01）. The number of granulocytes at T2 [（8.82±3.10）×10^9/L] was remarkably higher than that at T1 [（3.27±1.32）×10^9/L], which was more obvious than others. The number of monocytes at T2[（0.64±0.38）×10^9/L] was remarkably higher than that at T1 [（0.43± 0.18）×10^9/L]（P〈0.01）. The number of lymphoeytes at T2[（1.29±0.47）×10^9/L] was markedly lower than that at T1[（1.73±0.56）×10^9/L]（P〈 0.01）. The MFI of β-EP in each type of leukocytes at T2 was markedly lower than that at T1 （P〈0.05）. The level of plasma β-EP at T2 was also significantly reduced compared with that at TI （P〈0.01）. Conclusions The number of peripheral leukocytes in patients under general anesthesia during perioperative period is increased, where the most increase can be attributed to the change of granulocytes, compared with reduced levels of leukoeytes and plasma β-EP. The cell number and β-EP level are associated with perioperative endogenous analgesia and stress reaction.