两种麻醉方案对肝癌切除术后肝功能、T淋巴细胞亚群和相关细胞因子的影响

Effects of Two Kinds of Anesthesia Methods on Postoperative Liver function,T-lymphocyte Subsets and Related Cytokines in Patients after Hepatectomy for Liver Cancer

目的观察静-吸复合全麻与硬膜外联合静脉麻醉对肝癌切除术后肝功能恢复情况及对外周血T淋巴细胞亚群和相关细胞因子的影响。方法选取2011年2月—2016年8月需经手术切除治疗的肝癌患者90例。根据麻醉方案不同分为对照组40例和观察组50例,对照组行静-吸复合全麻,观察组行硬膜外联合静脉麻醉。观察两组术中情况,比较两组麻醉前(T0)、术毕(T1)、术后24 h(T2)、术后48 h(T3)的T淋巴细胞亚群、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平以及麻醉前与术后1周丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血浆白蛋白(ALB)和总胆红素(TBIL)水平。并记录患者的不良反应情况。结果两组手术中出血量、补液量和尿量比较差异无统计学意义(P>0.05)。T1、T2和T3时,两组CD3+、CD4+、CD4+/CD8+和TNF-α水平低于T0时,观察组高于对照组(P<0.05);两组IL-6水平高于T0时,观察组低于对照组(P<0.05)。术后1周,两组ALT、AST和TBIL均高于麻醉前,且观察组高于对照组(P<0.05);两组ALB低于麻醉前,且观察组低于对照组(P<0.05)。两组气管插管刺激性咽痛发生率比较差异无统计学意义(P>0.05),且均未出现肾功能损伤。结论硬膜外联合静脉麻醉能减少麻醉药物对T淋巴细胞的影响,促进免疫功能的恢复,但对肝功能的恢复较静-吸复合全麻差。

Objective To observe effects of static-inhalation combined general anesthesia and epidural combined with intravenous anesthesia on postoperative recovery of liver function,T-lymphocyte subsets in peripheral blood and related cytokines in patients after hepatectomy for liver cancer.Methods A total of 90 patients with liver cancer,who needed undergo hepatectomy during February 2011 and August 2016 were divided into control group(n=40)and observation group(n=50)according to different anesthesia methods.Control group received static-inhalation combined general anesthesia,while observation group received epidural combined with intravenous anesthesia.In two groups,intraoperative conditions were observed;levels of T-lymphocyte subsets,interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)before anesthesia(T0),at the time of operation ending(T1),24 h after operation(T2)and 48 h after operation(T3),and level of alanine aminotransferase(ALT),aspartate aminotransferase(AST),plasma albumin(ALB)and total bilirubin(TBIL)before and in 1 week after anesthesia were compared.Incidence rates of adverse reactions were recorded in two groups.Results There were no significant differences in intraoperative bleeding,fluid replacement and urine volumes in two groups(P>0.05).At T1,T2 and T3,CD3+,CD4+,CD4+/CD8+and TNF-αlevels were significantly lower than those at T0 in two groups,and the levels in observation group were significantly higher than those in control group(P<0.05);IL-6 levels were significantly higher than those at T0 in two groups,and the levels in observation group were significantly lower than those in control group(P<0.05).In postoperative 1 week,ALT,AST and TBIL levels were significantly higher than those before anesthesia in two groups,and the levels in observation group were significantly higher than those in control group(P<0.05);ALB levels were significantly lower than those before anesthesia in two groups,and the level in observation group was significantly lower than that in control group(P<0.05).There was no significant difference in stimulatory sore throat of tracheal intubation between two groups(P>0.05),and there was no damage to kidney function.Conclusion Epidural combined with intravenous anesthesia can decrease damage of T-lymphocyte induced by narcotic and improve recovery of immune function,but its effect on recovery of liver function is worse than that by static-inhalation combined general anesthesia in patients after hepatectomy for liver cancer.