两种全麻方法对口腔鳞癌患者免疫功能影响的比较研究

Effect of Two Different General Anesthesia Methods on Immune Function of Oral Squamous Cell Carcinoma Patients:A Randomized Controlled Study

目的:评价两种全麻方法对口腔鳞癌患者免疫功能的影响。方法:筛选行择期手术的口腔鳞癌患者40例,随机分为DP组和S组(n=20),DP组以右美托咪定和异丙酚为主实施麻醉;S组以七氟醚为主实施麻醉。两组其它麻醉用药相同。分别于麻醉诱导前30 min(T0)、麻醉后3 h(T1)、术毕(T2)、术毕6 h(T3)、术毕24 h(T4)、术毕48 h(T5)采集静脉血,检测血清中免疫球蛋白(IgA、IgM、IgG)及免疫细胞因子(sIL-2Rα、IL-2、IL-6、IL-10)水平。结果:两组各指标,在组内多个时间点上与T0比较均存在统计学差异(P<0.05),但免疫球蛋白组间比较几乎无统计学差异,免疫细胞因子在组间除T0时刻外,其余时间点上均存在统计学差异(P<0.05)。在T4、T5时,sIL-2Rα和IL-6的浓度,S组高于DP组,IL-2的浓度S组低于DP组,差异均有统计学意义(P<0.05);IL-10浓度在T1~T4时,S组高于DP组,差异有统计学意义(P<0.05)。结论:两种全麻方法对患者的免疫功能均有不同程度的抑制作用,但右美托咪定联合异丙酚麻醉对循环中IL-2、IL-6、IL-10及sIL-2Rα浓度的影响较七氟醚麻醉轻,可能更有利于维持患者免疫功能。

Objective:To evaluate the effects of two different general anesthesia methods on perioperative immune function of patients undergoing radical treatment of oral squamous cell carcinoma and immediate repair of free flap defect.Methods:A total of 40 patients with oral squamous cell carcinoma who underwent elective surgery were enrolled and randomly divided into group DP and group S(n=20).In group DP,dexmedetomidine and propofol were used as main anesthetics,and in Group S,sevoflurane was used as the main anesthetic.Other anesthetics were the same in both groups.Venous blood samples were taken at six time-points:30 minutes before anaesthesia(T0),3 hours after anaesthesia(T1),at the end of the operation(T2);and 6 hours(T3),24 hours(T4)and 48 hours(T5)after operation.The serum concentrations of immunoglobulin(IgA,IgM,IgG)and immunocytokines(IL-2,IL-6,IL-10,sIL-2Rα)were measured.Results:All indicators were statistically different from T0 at multiple time points within groups(P<0.05),but immunoglobulins were not statistically different between two groups,while immunocytokines were statistically different between two groups except T0(P<0.05).At T4 and T5,the concentrations of sIL-2Rαand IL-6 in Group S were higher than those in group DP,while the concentration of IL-2 in group S was lower than that in group DP(P<0.05).The concentration of IL-10 in Group S was higher than that in group DP at T1 to T4(P<0.05).Conclusion:There was no statistical difference on immuneglobulins related to humoral immunity in patients under different general anesthesia methods.However,the level of IL-2,IL-6,IL-10,and sIL-2Rαin circulation can be better maintained by intravenous anesthesia based on propofol and dexmedetomidine,which may be more helpful to relieve the immune suppression induced by surgery.