全身麻醉不同通气策略对腹腔镜结直肠癌根治术患者细胞免疫的影响

Effect of different ventilation strategies of general anesthesia on cellular immunity in patients undergoing laparoscopic radical resection of colorectal cancer

目的探讨腹腔镜结直肠癌根治术患者术中采用不同的通气策略对其细胞免疫的影响,为肿瘤患者预后提供参考。方法选择我院2017年8月~2018年12月择期拟行腹腔镜结直肠恶性肿瘤根治术患者75例,ASA分级Ⅰ或Ⅱ级,采用随机数字表法随机分为3组:低PaCO2组(L组),术中维持PaCO2(25±5)mmHg;正常PaCO2组(N组),术中维持PaCO2(40±5)mmHg和高PaCO2组(H组),术中维持PaCO2(55±5)mmHg,每组25例。各组患者均采用相同的麻醉诱导及维持方法。分别于手术前一天清晨(T0)、手术结束离开麻醉复苏室前5 min(T1)、术后24 h(T2)、72 h(T3)四个时点采血标本,流式细胞仪检测血液TH1/TH2值、MTT法检测NK细胞活性水平,ELISA检测IL-2及IFN浓度。结果与T0时点比较,三组患者T1~3时的TH1/TH2值、NK细胞活性、IL-2和IFN浓度均降低(P<0.05);与L组比较,N组T1~3时点TH1/TH2值、NK细胞活性、IL-2和IFN浓度均显著降低(P<0.05);与L组和N组相比,H组T1~3时TH1/TH2值、NK细胞活性、IL-2和IFN浓度均明显降低(P<0.05)。结论腹腔镜结直肠癌根治术术中采用适度过度通气对患者细胞免疫功能具有一定保护作用。

Objective To investigate the effect of different ventilation strategies on the cellular immunity of patients undergoing laparoscopic radical resection of colorectal cancer,and to provide a reference for the prognosis of patients with cancer.Methods 75 patients who underwent elective laparoscopic radical mastectomy for radical malignancy were enrolled in our hospital from August 2017 to December 2018,with the ASA gradeⅠorⅡ.They were randomly divided into three groups:low PaCO2 group(group L)in which PaCO2 was maintained at(25±5)mmHg during operation,normal PaCO2 group(group N)in which PaCO2 was maintained at(40±5)mmHg,and high PaCO2 group(group H)in which PaCO2 was maintained at(55±5)mmHg,with 25 cases per group.The same anesthesia induction and maintenance methods were used in each group of patients.Blood samples were taken at 4 o'clock in the morning(T0)before the operation,5 min(T1)before leaving the anesthesia resuscitation room,24 h(T2)and 72 h(T3)after surgery.Flow cytometry was used to detect blood TH1/TH2 value.MTT assay was used to detect NK cell activity levels,and ELISA was used to detect IL-2 and IFN concentrations.Results Compared with those at the T0 time point,the TH1/TH2 values,NK cell activity,IL-2 and IFN concentrations in the three groups at T1 to T3 were decreased(P<0.05).Compared with those of the group L,the TH1/TH2 value,NK cell activity,IL-2 and IFN concentrations in the group N were significantly decreased at T1-3(P<0.05).Compared with those of the group L and group N,the TH1/TH2 value,NK cell activity,IL-2 and IFN concentrations in group H were significantly lower(P<0.05).Conclusion Moderate hyperventilation during laparoscopic radical resection of colorectal cancer has a protective effect on cellular immune function.