不同麻醉方法对肝癌切除术后患者肿瘤坏死因子-α、C反应蛋白以及T淋巴细胞亚群的影响

Effects of two different anesthesia methods on the levels of tumor necrosis factor α,C-reactive protein and T lymphocyte subsets after resection in patients with hepatocellular carcinoma

目的探究两种不同的麻醉方法对肝癌切除术后患者肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)以及T淋巴细胞亚群的影响。方法选取2013年12月~2014年10月肇庆市端州区妇幼保健院收治的原发性肝癌患者68例。将患者按随机数表法随机分为丙泊酚静脉麻醉组和七氟醚吸入麻醉组,分别采用丙泊酚静脉麻醉和七氟醚吸入麻醉进行手术。观察患者的手术相关指标及麻醉前、麻醉后、麻醉后1 d、麻醉后3 d TNF-α、CRP和T淋巴细胞亚群的变化。结果两组手术时间、术中失血量、术肛门排气时间及住院时间的差异无统计学意义(P>0.05);术后两组的TNF-α及CRP均比麻醉前高,差异有统计学意义(P<0.01),但两组间差异无统计学意义(P>0.05)。术后1和3 d两组的TNF-α及CRP均比麻醉前高,其中丙泊酚静脉麻醉组的TNF-α低于七氟醚吸入麻醉组,差异有统计学意义(P<0.05);两组患者术后、术后1 d的CD3+、CD4+、CD4+/CD8+均比麻醉前低,差异具有统计学意义(P<0.05)。在术后3 d两组患者的CD3+、CD4+、CD4+/CD8+均恢复到麻醉前水平,差异无统计学意义(P>0.05)。结论肝癌患者采用丙泊酚静脉麻醉较七氟醚吸入麻醉能够在一定程度上减轻机体的炎症反应,对T淋巴细胞免疫功能的抑制作用弱,改善预后。

Objective To investigate the effects of two different anesthesia methods on the levels of tumor necrosis factor α,C-reactive protein and T lymphocyte subsets after resection of hepatocellular carcinoma. Methods Sixty-eight patients with primary liver cancer admitted in our hospital from December 2013 to October 2014 were selected for this study. The patients were randomly divided into the propofol intravenous anesthesia group and the sevoflurane inhalation anesthesia group. The patients were treated with propofol intravenous anesthesia and sevoflurane inhalation anesthesia. The operation-related indexes of the patients were observed,and the changes of the surgical indicators,tumor necrosis factor α,C-reactive protein and T lymphocyte subsets were observed before and after anesthesia,1 day after anesthesia and 3 days after anesthesia. Results There was no significant difference in operation time,intraoperative blood loss,anal exhaust time or hospitalization time between the two groups（P〈0.05）.（2）The differences in the TNF-α levels were statistically significant（P〈0.01）,but there was no significant difference between the two groups（P〈0.05）. After 1 day and 3 days,TNF-α levels of the two groups were higher than before anesthesia,and the difference was statistically significant（P〈0.01）,and propofol intravenous anesthesia group TNF α under sevoflurane inhalation anesthesia group,and the difference was statistically significant（P〈0.05）.（3） There was no significant difference between the two groups（P〈0.05）,but there was no significant difference between the two groups（P〈0.05）.The CRP of the two groups after anesthesia was higher than that before anesthesia（P〈0.01）. The CRP in the propofol intravenous anesthesia group was lower than that in the sevoflurane anesthesia group,and the difference was statistically significant（P〈0.05）.（4）The CD3＋,CD4＋ and CD4＋/CD8＋ levels of the two groups were lower than those before the operation and 1 day after operation,and the difference was statistically significant（P〈0.05）. There were no significant differences in the level of CD3＋,CD4＋,and CD4＋/CD8＋ between the two groups at 3 days after the operation（P〈0.05）.Conclusion To a certain extent,compared to sevoflurane inhalation anesthesia,propofol intravenous anesthesia reduce the body＇s inflammatory response to the weakened T lymphocyte immune function and improve the prognosis in patients with liver cancer.