中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2011年
4期
410-412
,共3页
体温%食管肿瘤%T淋巴细胞%杀伤细胞,天然
體溫%食管腫瘤%T淋巴細胞%殺傷細胞,天然
체온%식관종류%T림파세포%살상세포,천연
Body temperature%Esophageal neoplasms%T-lymphocytes%Killer cells,natural
目的 探讨充气毯术中保温对食管癌根治术患者细胞免疫功能的影响.方法择期拟行食管癌根治术患者36例,性别不限,年龄≤64岁,体重指数＜30 kg/m2,ASA分级Ⅰ或Ⅱ级,随机分为常规保温组(C组)和充气毯术中保温组(T组),每组18例.T组患者麻醉诱导前采用充气毯保温,43℃预加热20 min,保温直至术毕.于麻醉诱导后气管插管前(T1)、诱导后30、60、120、180 min和术毕(T2-6)时测定体温,于T1,6时采用ELISA法测定血浆去甲肾上腺素、肾上腺素浓度,流式细胞仪测定外周血T淋巴细胞亚群及NK细胞百分比.结果 与T1时比较,T2-6时C组体温降低,T6时两组CD4+T细胞百分比、CD4+/ICD8+均明显降低,CD8+T细胞百分比、血浆去甲肾上腺素和肾上腺素浓度升高(P＜0.05);与C组比较,T组T2-6时体温升高,T1时血浆去甲肾上腺素和肾上腺素浓度升高,浓度变化率降低(P＜0.05).结论 充气毯术中保温效果良好,可降低应激反应,但对食管癌根治术患者细胞免疫功能无显著影响.
目的 探討充氣毯術中保溫對食管癌根治術患者細胞免疫功能的影響.方法擇期擬行食管癌根治術患者36例,性彆不限,年齡≤64歲,體重指數＜30 kg/m2,ASA分級Ⅰ或Ⅱ級,隨機分為常規保溫組(C組)和充氣毯術中保溫組(T組),每組18例.T組患者痳醉誘導前採用充氣毯保溫,43℃預加熱20 min,保溫直至術畢.于痳醉誘導後氣管插管前(T1)、誘導後30、60、120、180 min和術畢(T2-6)時測定體溫,于T1,6時採用ELISA法測定血漿去甲腎上腺素、腎上腺素濃度,流式細胞儀測定外週血T淋巴細胞亞群及NK細胞百分比.結果 與T1時比較,T2-6時C組體溫降低,T6時兩組CD4+T細胞百分比、CD4+/ICD8+均明顯降低,CD8+T細胞百分比、血漿去甲腎上腺素和腎上腺素濃度升高(P＜0.05);與C組比較,T組T2-6時體溫升高,T1時血漿去甲腎上腺素和腎上腺素濃度升高,濃度變化率降低(P＜0.05).結論 充氣毯術中保溫效果良好,可降低應激反應,但對食管癌根治術患者細胞免疫功能無顯著影響.
목적 탐토충기담술중보온대식관암근치술환자세포면역공능적영향.방법택기의행식관암근치술환자36례,성별불한,년령≤64세,체중지수＜30 kg/m2,ASA분급Ⅰ혹Ⅱ급,수궤분위상규보온조(C조)화충기담술중보온조(T조),매조18례.T조환자마취유도전채용충기담보온,43℃예가열20 min,보온직지술필.우마취유도후기관삽관전(T1)、유도후30、60、120、180 min화술필(T2-6)시측정체온,우T1,6시채용ELISA법측정혈장거갑신상선소、신상선소농도,류식세포의측정외주혈T림파세포아군급NK세포백분비.결과 여T1시비교,T2-6시C조체온강저,T6시량조CD4+T세포백분비、CD4+/ICD8+균명현강저,CD8+T세포백분비、혈장거갑신상선소화신상선소농도승고(P＜0.05);여C조비교,T조T2-6시체온승고,T1시혈장거갑신상선소화신상선소농도승고,농도변화솔강저(P＜0.05).결론 충기담술중보온효과량호,가강저응격반응,단대식관암근치술환자세포면역공능무현저영향.
Objective To investigate the effect of forced-air warming system on the cellular immune function during radical esophagus cancer resection. Methods Thirty-six ASA Ⅰ or Ⅱ patients of both sexes, aged ≤ 64 yr, with body mass index ＜ 30 kg/m2 , scheduled for elective radical esophagus cancer resection, were randomized to 2 groups ( n = 18 each): normal temperature care group (group C) and forced-air wanning group (group T) . Anesthesia was induced with midazolam, sufentanil, propofol and vecuronium. The patients were tracheal intubated and mechanically ventilated. The patients were not warmed intraoperatively in group C. In group T, the patients were prewarmed for 20 min at 43℃, using forced-air warming system before induction and then kept warm until the end of operation. The nasopharyngeal temperature was measured at 0, 30, 60, 120 and 180 min after anesthesia induction and at the end of operation (T1-6 ) to reflect the body temperature. Venous blood samples were taken at T1,6 for analysis of T-lymphocyte subsets (CD3+ , CD4+ , CD8+ , CD4+ /CD8+ ) and NK cells (by flow cytometry) and determination of the plasma concentrations of noradrenaline and adrenaline (by ELISA) . Results Compared with T1 , the body temperature was significantly decreased at T2-6 in group C, and the percentage of CD4+ cells and CD4+ /CD8+ ratio were significantly decreased and the percentage of CD8+ and plasma concentrations of noradrenaline and adrenaline increased at T6 in both groups ( P ＜ 0.05). Compared with group C, the body temperature was significantly increased at T2-6, plasma concentrations of noradrenaline and adrenaline were significantly increased at T, , while the change rate of concentrations was significantly decreased in group T ( P ＜ 0.05) . ConclusionThe efficiency of forced-air warming system in maintaining perioperative normothermia is good and it reduces the stress response, but it exerts no influence on the cellular immune function in patients undergoing radical esophagus cancer resection.
