麻醉方式对直肠癌患者CD4^+CD25^+Foxp3^+Treg水平及预后的影响

Influence of different anesthesia on level of CD4^+CD25^+Foxp3^+ Treg cells and prognosis of patients with rectal cancer

目的探讨不同麻醉方式对直肠癌手术患者CD4^+CD25^+Foxp3^+Treg水平及其预后的影响。方法选取2011年1月-2012年12月于陕西省人民医院行CO_2气腹腹腔镜下直肠癌手术的患者143例。比较单纯全身麻醉(GA)、硬膜外复合全身麻醉(EA)及硬膜外复合全身麻醉下6%羟乙基淀粉液急性高容量血液稀释(EA^+AHH)麻醉对患者术中一般情况、术前和术后1个月外周血CD4^+CD25^+Foxp3^+Treg水平及3年随访生存率的影响。结果 EA^+AHH组患者术中血压波动幅度小于其余两组患者。与术前比较,EA^+AHH组术后1个月外周血CD4^+CD25^+Foxp3^+/CD4^+下降幅度大于其余两组,术后3年生存率高于其余两组(P<0.05)。结论 EA^+AHH麻醉可改善CO_2气腹腹腔镜下直肠癌手术患者术后细胞免疫状态及预后,值得在临床推广应用。

Objective To investigate the influence of three different anesthesia on level of CD4+CD25+Foxp3+Treg cells and prognosis of patients with rectal cancer undergoing CO2 pneumoperitoneum laparoscopic surgery.Methods A prospective cohort study was carried out in 143 adult patients,who received colorectal cancer surgery under CO2 pneumoperitoneum laparoscope in our hospital between January 2011 and December 2012.The hemodynamic changes in the patients with general anesthesia(GA),combined epidural and general anesthesia(EA),and EA combined with 6%hydroxyethyl starch solution acute hemodilution(EA+AHH)during surgery,the level of CD4+CD25+Foxp3+Treg cells before operation and 1 month after operation and the survival rate of 3-year follow-up were compared between the three groups.Results Compared with the other two groups,the intraoperative blood pressure fluctuation was smaller,the decreased range of CD4+CD25+Foxp3+/CD4+T cell ratio in peripheral blood 1 month after surgery was greater,and the 3-year survival rate was significantly higher in the(EA+AHH)group(P<0.05).There was no statistically significant difference between the GA and EA groups(P>0.05).Conclusions Acute hypervolemic hemodilution using 6%hydroxyethyl starch combined with epidural anesthesia can significantly improve the immune status and prognosis of the patients with rectal cancer undergoing CO2 pneumoperitoneum laparoscopic surgery.