依托咪酯全凭静脉麻醉对老年骨科手术患者围术期T淋巴细胞亚群水平的影响

Effect of Etomidate Total Intravenous Anesthesia on Perioperative T Lymphocyte Subsets in Elderly Patients Undergoing Orthopaedic Surgery

为了探讨依托咪酯全凭静脉麻醉对老年骨科手术患者围术期T淋巴细胞亚群水平的影响。本研究选取2015年6月至2016年6月在本院骨科收治的65岁以上老年患者59例作为研究对象,随机分为两组,对照组30例,采用丙泊酚进行麻醉;实验组29例,采用依托咪酯。记录患者术中情况及术后不良反应,并于麻醉前30 min（T0）、手术结束后30 min（T1）及术后24 h（T2）采用流式细胞仪检测患者外周血中T淋巴细胞亚群（CD3^＋,CD4^＋,CD8^＋及CD4^＋/CD8^＋）的变化。结果显示,两组患者术后麻醉时间、手术时间、失血量及术后不良反应发生率均无统计学差异（p〉0.05）。与T0时比较,T1时实验组和对照组的CD3^＋、CD4^＋、CD8^＋及CD4^＋/CD8^＋均显著降低（p〈0.05）,但两组之间比较差异无统计学意义（p〉0.05）;T2时实验组CD3^＋、CD4^＋、及CD4^＋/CD8^＋均显著高于对照组（p〈0.05）,两组间CD8^＋比较差异无统计学意义（p〉0.05）。依托咪酯全凭静脉麻醉能够部分减轻老年骨科患者术后免疫抑制程度,且术后患者恢复较快。

To investigate the effect of etomidate total intravenous anesthesia on perioperative T-lymphocyte subsets in elderly patients undergoing orthopedic surgery. In this study, 59 patients aged 65 years or older who were treated in orthopaedics at our hospital from June 2015 to June 2016 were selected as study subjects. They were randomly divided into two groups. The control group consisted of 30 patients and received propofol for anesthesia. The experimental group consisted of 29 patients and received etomidate. The patient＇s intraoperative conditions and postoperative adverse reactions were recorded. T lymphocytes subpopulations in peripheral blood（CD3^＋, CD4^＋, CD8^＋, and CD4^＋/CD8^＋） were measured by flow cytometry 30 minutes before anesthesia（T0）, 30 minutes after the end of surgery（T1）, and 24 hours after surgery（T2）. The results showed that there was no significant difference in postoperative anesthesia time, operation time, blood loss, and postoperative adverse reactions between the two groups（p〉0.05）. Compared with T0, the levels of CD3^＋, CD4^＋, CD8^＋, and CD4^＋/CD8^＋in experimental group and control group were significantly decreased at T1（p〈0.05）, but there was no significant difference between the two groups（p〉0.05）; The levels of CD3^＋, CD4^＋, and CD4^＋/CD8^＋in the experimental group were significantly higher than those in the control group at T2（p〈0.05）, but there was no significant difference in CD8^＋between the two groups（p〉0.05）. Etomidate total intravenous anesthesia partially reduced the degree of postoperative immunosuppression in elderly orthopaedic patients, and patients recovered faster after surgery.