不同麻醉方法对口腔鳞癌患者免疫功能的影响

Effects of different anesthesia methods on immune function in patients with oral squamous cell carcinoma

目的评价不同麻醉方法对口腔鳞癌患者免疫功能的影响。方法择期行口腔鳞癌根治术及游离皮瓣缺损修复术患者40例,性别不限,年龄31~64岁,BMI 19~23 kg/m^(2),ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为静吸复合麻醉组(VICA组)和全凭静脉麻醉组(TIVA组),每组20例。VICA组静脉注射丙泊酚1.5~2.0 mg/kg、瑞芬太尼1~2μg/kg和顺阿曲库铵0.2 mg/kg麻醉诱导,持续吸入七氟烷,维持1.3 MAC,手术结束前1 h停止吸入,更换丙泊酚4~6 mg·kg^(-1)·h^(-1)持续输注,直至手术结束,同时静脉输注右美托咪定0.4μg·kg^(-1)·h^(-1)、瑞芬太尼0.2~0.3μg·kg^(-1)·min^(-1)和顺阿曲库铵0.1 mg·kg^(-1)·h^(-1)维持麻醉;TIVA组麻醉诱导同VICA组,麻醉维持采用静脉输注右美托咪定0.4μg·kg^(-1)·h^(-1)、丙泊酚4~6 mg·kg^(-1)·h^(-1)、瑞芬太尼0.2~0.3μg·kg^(-1)·min^(-1)和顺阿曲库铵0.1 mg·kg^(-1)·h^(-1)。分别于麻醉诱导前30 min(T_(0))、麻醉后3 h(T_(1))、术毕(T_(2))、术后6 h(T_(3))、术后24 h(T_(4))和术后48 h(T_(5))时采集静脉血样,采用ELISA法检测血清免疫球蛋白(IgA、IgM和IgG)及免疫细胞因子[IL-2、IL-6、IL-10和可溶性白细胞介素2受体α(sIL-2Rα)]浓度。结果与T_(0)时比较,2组T_(1)~5时血清sIL-2Rα浓度、T_(1)~4时血清IL-2浓度和T_(1)时血清IL-10浓度降低,T_(1)~5时血清IL-6浓度和T_(2)~4时血清IL-10浓度升高,T_(1)~5时血清IgA浓度、血清IgM浓度、TIVA组T_(1)~5时和VICA组T_(1),2、T_(4),5时血清IgG浓度降低(P<0.05)。与TIVA组比较,VICA组T_(2),5时血清sIL-2Rα浓度、T_(4),5时血清IL-6浓度和T_(3)时血清IL-10浓度、T_(4)时血清IgA浓度、T_(3)时血清IgG浓度升高,T_(1)~5时血清IL-2浓度、T_(5)时血清IgA浓度降低(P<0.05)。结论两种麻醉方法对口腔鳞癌患者术中、术后细胞免疫和体液免疫功能均有抑制作用,静吸复合麻醉对细胞免疫功能的抑制作用高于全凭静脉麻醉。

Objective To evaluate the effect of different anesthesia methods on the immune function in the patients with oral squamous cell carcinoma.Methods Forty patients of both sexes,aged 31-64 yr,with body mass index of 19-23 kg/m^(2),of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,undergoing elective radical resection of oral squamous cell carcinoma and repair of the defect with free flap,were enrolled and randomized to receive either combined intravenous-inhalational anesthesia(VICA group,n=20)or total intravenous anesthesia(TIVA group,n=20)using a random number table method.In group VICA,anesthesia was induced with intravenous propofol 1.5-2.0 mg/kg,remifentanil 1-2μg/kg,and cisatracurium 0.2 mg/kg,sevoflurane was continuously inhaled to maintain MAC at 1.3,sevoflurane inhalation was stopped at 1 h before the end of surgery,sevoflurane was replaced with propofol,propofol 4-6 mg·kg^(-1)·h^(-1)was continuously infused until the end of operation,and dexmedetomidine 0.4μg·kg^(-1)·h^(-1),remifentanil 0.2-0.3μg·kg^(-1)·min^(-1)and cisatracurium 0.1 mg·kg^(-1)·h^(-1)were intravenously infused at the same time to maintain anesthesia.In group TIVA,anesthesia induction was the same as those previously described in group VICA,and anesthesia was maintained with intravenous dexmedetomidine 0.4μg·kg^(-1)·h^(-1),propofol 4-6 mg·kg^(-1)·h^(-1),remifentanil 0.2-0.3μg·kg^(-1)·min^(-1)and cisatracurium 0.1 mg·kg^(-1)·h^(-1).Venous blood samples were taken at 30 min before anaesthesia induction(T_(0)),3 h after anaesthesia(T_(1)),at the end of operation(T_(2)),and at 6,24 and 48 h after operation(T_(3)-5)for determination of the serum concentrations of immunoglobulins(IgA,IgM,IgG),interleukins(IL-2,IL-6,IL-10,sIL-2Rα)and soluble interleukin-2 receptor alpha(sIL-2Rα)by enzyme-linked immunosorbent assay.Results Compared with the baseline at T_(0),the concentrations of serum sIL-2Rαat T_(1)-5,IL-2 at T_(1)-4 and IL-10 at T_(1)were significantly decreased,the concentrations of serum IL-6 at T_(1)-5 and IL-10 at T_(2)-4 were increased,and the concentrations of serum IgA and IgM at T_(1)-5 were decreased in two groups,and the concentrations of serum IgG at T_(1)-5 in TIVA group and at T_(1),2 and T_(4),5 in VICA group were significantly decreased(P<0.05).Compared with group TIVA,the concentrations of serum sIL-2Rαat T_(2),5,IL-6 at T_(4),5 and IL-10 at T_(3),IgA at T_(4)and IgG at T_(3)were significantly increased,and the concentrations of serum IL-2 at T_(1)-5 and IgA at T_(5)were decreased in group VICA(P<0.05).Conclusions Both general anesthesia methods have significant inhibitory effects on intraoperative and postoperative cellular immune function and humoral immune function in the patients with oral squamous cell carcinoma,and combined intravenous-inhalational anesthesia produces higher inhibitory effects on cellular immune function than total intravenous anesthesia.