南方医科大学学报
南方醫科大學學報
남방의과대학학보
JOURNAL OF SOUTHERN MEDICAL UNIVERSITY
2010年
2期
284-287
,共4页
食管肿瘤/麻醉%镇痛%胸部硬膜外麻醉%细胞免疫%应激激素
食管腫瘤/痳醉%鎮痛%胸部硬膜外痳醉%細胞免疫%應激激素
식관종류/마취%진통%흉부경막외마취%세포면역%응격격소
esophagus neoplasms/anesthesiology%analgesia%thoracic epidural anesthesia%cellular immune function%stress hormone
目的 观察不同麻醉和镇痛方法下食管癌手术患者术中和术后外周静脉血T淋巴细胞亚群和相关细胞因子及应激激素水平的变化.方法 选择60例择期食管癌手术病人,随机分为两组:A组采用全凭静脉麻醉,术后行患者自控静脉镇痛;B组采用胸段硬膜外阻滞复合静脉全麻,术后行患者自控硬膜外镇痛,每组30例.分别于麻醉前(T_0)、切皮后2 h(T_1)、术后4 h(T_2)、术后24 h(T_3)、术后48 h(T_4)抽取两组患者静脉血,流式细胞术测定CD4~+%和CD8~+%,计算CD4~+/CD8~+比值,ELISA法测定各时间点血清白介素-2(IL-2)和可溶性白介素-2受体(sIL-2R):并用放射免疫法测定各时段的血清应激激素生长激素(GH)、催乳素(PRL)、白介素-8(IL-8)及皮质醇(Cor)的含量.结果 (I)B组T_2、T_3时点的VAS评分均明显低于A组(P<0.05);(2)除CD8~+%外,两组CD4~+% 、CD4~+/CD8~+比值从T_1开始下降(P<0.05),T_2时B组降至最低(P<0.01),T_3时A组降至最低(P<0.05);T_1至T_4时点B组CD4~+%明显高于A组(P<0.05),T_3至T_4时点B组CD4~+/CD8~+比值明显高于A组(P<0.05);T_1时两组的IL-2水平开始下降,T_2时B组降至最低(P<0.05),T_3时A组降至最低(P<0.05),T_3和T_4时B组IL-2水平明显高于A组(P<0.05);两组sIL-2R水平从T_1开始升高,A组T_2时显著高于麻醉前水平,T_1达最高峰;而B组各时间点与T0比较差异无统计学意义(P>0.05);两组间比较,T_2至T_4时A组sIL-2R水平明显高于B组(P<0.05).(3)两组血清GH、PRL和Cor浓度均呈增高趋势(P<0.05).而血清IL-8浓度呈下降趋势(P<0.05);B组术中、术后各时间点GH、PRL、Cor及IL-8指标波动均较A组平稳.结论在麻醉和术后镇痛中辅以胸段硬膜外阻滞能减轻食管癌患者围手术期应激反应及其对细胞免疫功能的抑制作用.
目的 觀察不同痳醉和鎮痛方法下食管癌手術患者術中和術後外週靜脈血T淋巴細胞亞群和相關細胞因子及應激激素水平的變化.方法 選擇60例擇期食管癌手術病人,隨機分為兩組:A組採用全憑靜脈痳醉,術後行患者自控靜脈鎮痛;B組採用胸段硬膜外阻滯複閤靜脈全痳,術後行患者自控硬膜外鎮痛,每組30例.分彆于痳醉前(T_0)、切皮後2 h(T_1)、術後4 h(T_2)、術後24 h(T_3)、術後48 h(T_4)抽取兩組患者靜脈血,流式細胞術測定CD4~+%和CD8~+%,計算CD4~+/CD8~+比值,ELISA法測定各時間點血清白介素-2(IL-2)和可溶性白介素-2受體(sIL-2R):併用放射免疫法測定各時段的血清應激激素生長激素(GH)、催乳素(PRL)、白介素-8(IL-8)及皮質醇(Cor)的含量.結果 (I)B組T_2、T_3時點的VAS評分均明顯低于A組(P<0.05);(2)除CD8~+%外,兩組CD4~+% 、CD4~+/CD8~+比值從T_1開始下降(P<0.05),T_2時B組降至最低(P<0.01),T_3時A組降至最低(P<0.05);T_1至T_4時點B組CD4~+%明顯高于A組(P<0.05),T_3至T_4時點B組CD4~+/CD8~+比值明顯高于A組(P<0.05);T_1時兩組的IL-2水平開始下降,T_2時B組降至最低(P<0.05),T_3時A組降至最低(P<0.05),T_3和T_4時B組IL-2水平明顯高于A組(P<0.05);兩組sIL-2R水平從T_1開始升高,A組T_2時顯著高于痳醉前水平,T_1達最高峰;而B組各時間點與T0比較差異無統計學意義(P>0.05);兩組間比較,T_2至T_4時A組sIL-2R水平明顯高于B組(P<0.05).(3)兩組血清GH、PRL和Cor濃度均呈增高趨勢(P<0.05).而血清IL-8濃度呈下降趨勢(P<0.05);B組術中、術後各時間點GH、PRL、Cor及IL-8指標波動均較A組平穩.結論在痳醉和術後鎮痛中輔以胸段硬膜外阻滯能減輕食管癌患者圍手術期應激反應及其對細胞免疫功能的抑製作用.
목적 관찰불동마취화진통방법하식관암수술환자술중화술후외주정맥혈T림파세포아군화상관세포인자급응격격소수평적변화.방법 선택60례택기식관암수술병인,수궤분위량조:A조채용전빙정맥마취,술후행환자자공정맥진통;B조채용흉단경막외조체복합정맥전마,술후행환자자공경막외진통,매조30례.분별우마취전(T_0)、절피후2 h(T_1)、술후4 h(T_2)、술후24 h(T_3)、술후48 h(T_4)추취량조환자정맥혈,류식세포술측정CD4~+%화CD8~+%,계산CD4~+/CD8~+비치,ELISA법측정각시간점혈청백개소-2(IL-2)화가용성백개소-2수체(sIL-2R):병용방사면역법측정각시단적혈청응격격소생장격소(GH)、최유소(PRL)、백개소-8(IL-8)급피질순(Cor)적함량.결과 (I)B조T_2、T_3시점적VAS평분균명현저우A조(P<0.05);(2)제CD8~+%외,량조CD4~+% 、CD4~+/CD8~+비치종T_1개시하강(P<0.05),T_2시B조강지최저(P<0.01),T_3시A조강지최저(P<0.05);T_1지T_4시점B조CD4~+%명현고우A조(P<0.05),T_3지T_4시점B조CD4~+/CD8~+비치명현고우A조(P<0.05);T_1시량조적IL-2수평개시하강,T_2시B조강지최저(P<0.05),T_3시A조강지최저(P<0.05),T_3화T_4시B조IL-2수평명현고우A조(P<0.05);량조sIL-2R수평종T_1개시승고,A조T_2시현저고우마취전수평,T_1체최고봉;이B조각시간점여T0비교차이무통계학의의(P>0.05);량조간비교,T_2지T_4시A조sIL-2R수평명현고우B조(P<0.05).(3)량조혈청GH、PRL화Cor농도균정증고추세(P<0.05).이혈청IL-8농도정하강추세(P<0.05);B조술중、술후각시간점GH、PRL、Cor급IL-8지표파동균교A조평은.결론재마취화술후진통중보이흉단경막외조체능감경식관암환자위수술기응격반응급기대세포면역공능적억제작용.
Objective To investigate the effects of different anesthetic and analgesic protocols on the cellular immune function and stress hormone in patients undergoing lobectomy for esophagus cancer. Methods Sixty ASA I or II patients undergoing lobectomy for esophagus cancer were randomly divided into two groups to receive postoperative general anesthesia and intravenous analgesia (group A, n=30) or intraoperative general anesthesia combined with thoracic epidural anesthesia with postoperative epidural analgesia (group B, n=30). The cervical venous blood samples were obtained from the patients at 30 rain before anesthesia induction (T_0), 2 h after skin incision (T_1), and at 4 h (T_2), 24 h (T_3) and 48 h (T_4) after the end of operation. The T-lymphocyte subsets (CD4~+ and CD8~+) were analyzed by flow cytometry, serum concentrations of slL-2R and IL-2 determined by ELISA, and the levels of growth hormone (GR), prolactin (PRL), IL-8 and cortisol (Cur) measured by radioimmunoassay. Visual analogue scale (VAS) was used for assessment of the postoperative analgesic effects. Results The VAS scores were significantly lower in group B than in group A at T_2 and.T_3 (P<0.05). The percentage of CD4~+ cells and the CD4~+/CD8~+ ratio in the two groups began to decrease significantly at T_1 (P<0.05), reducing to the lowest level at T_2 in group B and at T_3 in group A. From T_1 to T_4, the percentage of CD4~+ in group B remained significantly higher than those in group A (P<0.05), and from T_3 to T_4, the CD4~+/CD8~+ ratio in group B were significantly higher than those in group A (P<0.05). The IL-2 level in the two groups began to decrease significantly at T_1 (P<0.05), reaching the lowest level at T_2 in group A and at T_3 in group A. IL-2 level was significantly higher in group B than in group A from T_3 to T_4 (P<0.05). sIL-2R level in group A began to increase at T_1 and peaked at T_3, showing significant differences from the T0 level, but the level showed no significant variations in group B compared with the T0 level. From T_2 to T_4, sIL-2R level was significantly higher in group A than in group B (P<0.05). The levels of GH, PRL and Cur increased significantly, while IL-8 decreased in the two groups from T_1 to T_4 (P<0.05), but remained stable in group B. Conclusion General anesthesia combined with thoracic epidural anesthesia may reduce the perioperative stress reaction and adverse effect on cellular immune function in patients undergoing lobectomy for esophagus cancer.
