全凭静脉麻醉与平衡麻醉对膀胱根治性切除术患者免疫调节影响的比较

Effects of total intravenous anesthesia versus balanced anesthesia on immune regulation in patients undergoing elective radical cystectomy

目的探讨比较全凭静脉麻醉与平衡麻醉对根治性膀胱切除术患者免疫调节的影响。方法选取2017年1月至2020年6月在本院行膀胱根治性切除术的95例膀胱癌患者为研究对象。随机将其分为A组(47例)与B组(48例),A组患者给予靶控输注全凭静脉麻醉,B组患者给予平衡吸入麻醉。观察两组患者的围手术期指标、炎性细胞因子水平及不良反应情况。结果两组患者在诱导麻醉前(T0)、术后6 h(T1)、术后5 d(T2)时,血红蛋白(Hb)、血细胞比容(HCT)、乳酸水平比较,差异均无统计学意义(P>0.05);T0时,两组Hb、HCT、乳酸水平及疼痛评分均高于T1、T2时的水平(P<0.05)。A组患者T0时的白介素-6(IL-6)水平低于T1、T2时的水平,T0、T1时的干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)水平低于T2时的水平,T0时的淋巴细胞高于T1、T2时的水平,T2时的嗜酸性粒细胞水平高于T0、T1时的水平,T0时的嗜碱性粒细胞水平高于T1、T2时的水平(均P<0.05);B组在T0时的IL-6水平低于T1、T2时的水平,T2时的TNF-α水平高于T0、T1时的水平,T0时的淋巴细胞、嗜酸性粒细胞、嗜碱性粒细胞水平高于T1时的水平,T0时的调节性T细胞(Tregs)高于T1、T2(均P<0.05)。T2时,A组患者的IFN-γ、TNF-α水平高于B组,淋巴细胞水平低于B组,T0时,A组患者的嗜酸性粒细胞水平低于B组(均P<0.05);T1时,A组患者的嗜酸性粒细胞水平高于B组,T2时,A组患者的嗜酸性粒细胞水平低于B组,T0、T2时,A组患者的嗜碱性粒细胞水平均高于B组(均P<0.05)。两组患者的生存率与术后转移率比较,差异均无统计学意义(均P>0.05)。结论全凭静脉麻醉与平衡麻醉可调节择期膀胱根治性切除术患者的免疫反应,不易引起病情恶性。

Objective To investigate the effects of total intravenous anesthesia versus balanced anesthesia on immune regulation in patients undergoing elective radical cystectomy.Methods Ninety-five patients with bladder cancer who underwent radical cystectomy in our hospital from January 2017 to June 2020 were selected as the study subjects.They were randomly divided into group A(47 cases)and group B(48 cases).Group A was given total intravenous anesthesia by target-controlled infusion,and group B was given balanced inhalation anesthesia.Then the perioperative indexes,inflammatory cytokine levels,and adverse reactions were compared between groups.Results There were no significant differences in hemoglobin(Hb),hematocrit(HCT)and lactic acid levels between 2 groups before induction of anesthesia(T0),6 h after surgery(T1)and 5 d after surgery(T2)(P>0.05).The Hb,HCT,lactic acid levels and pain scores of group A and B at T0 were significantly higher than those at T1 and T2(P<0.05).Within group A,IL-6 levels at T0 were lower than those at T1 and T2,IFN-γand TNF-αlevels at T0 and T1 were lower than those at T2,lymphocyte level at T0 was higher than that at T1 and T2,eosinophils level at T2 was higher than that at T0 and T1,and the level of basophils at T0 was higher than that at T1 and T2(all P<0.05).Within group B,IL-6 level at T0 was lower than that at T1 and T2,TNF-αlevel at T2 was higher than that at T0 and T1,the levels of lymphocytes,eosinophils,and basophils at T0 were higher than those at T1,and Tregs levels at T0 were significantly higher than those at T1 and T2(all P<0.05).At T2,levels of IFN-γand TNF-αin group A were higher than those in group B,and the levels of lymphocytes and eosinophils in group A were lower than those in group B.At T0,the level of eosinophils in group A was lower than that in group B.At T1,the level of eosinophils in group A was higher than that in group B.The levels of basophils in group A were higher than those in group B at T0 and T2.No significant difference was found in other indicators(P>0.05).The survival rate and postoperative metastasis rate showed no significant difference between two groups(P>0.05).Conclusions The increase of Treg level during total intravenous anesthesia and the decrease of Tregs level during balanced anesthesia can balance the IL-6 induced immunosuppression response.Therefore,both anesthesia methods are effective in elective radical cystectomy,without worsening the conditions.