中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2011年
6期
657-660
,共4页
张铁军%王焱林%陈焰%刘可斌
張鐵軍%王焱林%陳燄%劉可斌
장철군%왕염림%진염%류가빈
麻醉,全身%免疫%口腔肿瘤
痳醉,全身%免疫%口腔腫瘤
마취,전신%면역%구강종류
Anesthesia,general%Immunity%Mouth neoplasms
目的 评价不同全麻对口腔恶性肿瘤患者免疫功能的影响.方法 择期拟行口腔恶性肿瘤根治术患者60例,年龄49～64岁,体重50～71kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为3组(n=20):Ⅰ组采用全凭静脉麻醉,静脉注射眯达唑仑、瑞芬太尼、顺阿曲库铵和异丙酚麻醉诱导,静脉输注异丙酚和瑞芬太尼维持麻醉;Ⅱ组采用静吸复合麻醉,麻醉诱导同Ⅰ组,吸入七氟醚或静脉输注异丙酚复合瑞芬太尼维持麻醉;Ⅲ组采用吸入全麻,吸入七氟醚,静脉注射瑞芬太尼和顺阿曲库铵麻醉诱导,吸入七氟醚,静脉输注瑞芬太尼维持麻醉.于麻醉诱导前30 min(T0)、麻醉后1、3、5 h、术毕、术后24、48、72 h(T2～7)时采集外周静脉血,采用流式细胞仪测定T淋巴细胞亚群及NK细胞、B淋巴细胞百分比.结果 与T0时比较,Ⅰ组～Ⅲ组T1-5时CD3+、CD4+、CD4+/CD8+比值、NK细胞百分比和B淋巴细胞百分比降低,Ⅱ组和Ⅲ组T6时CD3+、CD4+、CD4+/CD8+比值及NK细胞百分比降低(P＜0.05或0.01);与Ⅰ组比较,Ⅱ组T2,3,6时CD4+、CD4+/CD8+比值和Ⅲ组T2～6时CD3+、CD4+、CD4+/CD8+比值及NK细胞百分比降低(P＜0.05或0.01);与Ⅱ组比较,Ⅲ组T4.5时CD4+、CD4+/CD8+比值及NK细胞百分比降低(P＜0.05).结论 与吸人麻醉和静吸复合麻醉比较,咪达唑仑、瑞芬太尼和异丙酚全凭静脉麻醉对口腔恶性肿瘤患者免疫功能的抑制程度较低.
目的 評價不同全痳對口腔噁性腫瘤患者免疫功能的影響.方法 擇期擬行口腔噁性腫瘤根治術患者60例,年齡49～64歲,體重50～71kg,ASA分級Ⅰ或Ⅱ級,採用隨機數字錶法,將患者隨機分為3組(n=20):Ⅰ組採用全憑靜脈痳醉,靜脈註射瞇達唑崙、瑞芬太尼、順阿麯庫銨和異丙酚痳醉誘導,靜脈輸註異丙酚和瑞芬太尼維持痳醉;Ⅱ組採用靜吸複閤痳醉,痳醉誘導同Ⅰ組,吸入七氟醚或靜脈輸註異丙酚複閤瑞芬太尼維持痳醉;Ⅲ組採用吸入全痳,吸入七氟醚,靜脈註射瑞芬太尼和順阿麯庫銨痳醉誘導,吸入七氟醚,靜脈輸註瑞芬太尼維持痳醉.于痳醉誘導前30 min(T0)、痳醉後1、3、5 h、術畢、術後24、48、72 h(T2～7)時採集外週靜脈血,採用流式細胞儀測定T淋巴細胞亞群及NK細胞、B淋巴細胞百分比.結果 與T0時比較,Ⅰ組～Ⅲ組T1-5時CD3+、CD4+、CD4+/CD8+比值、NK細胞百分比和B淋巴細胞百分比降低,Ⅱ組和Ⅲ組T6時CD3+、CD4+、CD4+/CD8+比值及NK細胞百分比降低(P＜0.05或0.01);與Ⅰ組比較,Ⅱ組T2,3,6時CD4+、CD4+/CD8+比值和Ⅲ組T2～6時CD3+、CD4+、CD4+/CD8+比值及NK細胞百分比降低(P＜0.05或0.01);與Ⅱ組比較,Ⅲ組T4.5時CD4+、CD4+/CD8+比值及NK細胞百分比降低(P＜0.05).結論 與吸人痳醉和靜吸複閤痳醉比較,咪達唑崙、瑞芬太尼和異丙酚全憑靜脈痳醉對口腔噁性腫瘤患者免疫功能的抑製程度較低.
목적 평개불동전마대구강악성종류환자면역공능적영향.방법 택기의행구강악성종류근치술환자60례,년령49～64세,체중50～71kg,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장환자수궤분위3조(n=20):Ⅰ조채용전빙정맥마취,정맥주사미체서륜、서분태니、순아곡고안화이병분마취유도,정맥수주이병분화서분태니유지마취;Ⅱ조채용정흡복합마취,마취유도동Ⅰ조,흡입칠불미혹정맥수주이병분복합서분태니유지마취;Ⅲ조채용흡입전마,흡입칠불미,정맥주사서분태니화순아곡고안마취유도,흡입칠불미,정맥수주서분태니유지마취.우마취유도전30 min(T0)、마취후1、3、5 h、술필、술후24、48、72 h(T2～7)시채집외주정맥혈,채용류식세포의측정T림파세포아군급NK세포、B림파세포백분비.결과 여T0시비교,Ⅰ조～Ⅲ조T1-5시CD3+、CD4+、CD4+/CD8+비치、NK세포백분비화B림파세포백분비강저,Ⅱ조화Ⅲ조T6시CD3+、CD4+、CD4+/CD8+비치급NK세포백분비강저(P＜0.05혹0.01);여Ⅰ조비교,Ⅱ조T2,3,6시CD4+、CD4+/CD8+비치화Ⅲ조T2～6시CD3+、CD4+、CD4+/CD8+비치급NK세포백분비강저(P＜0.05혹0.01);여Ⅱ조비교,Ⅲ조T4.5시CD4+、CD4+/CD8+비치급NK세포백분비강저(P＜0.05).결론 여흡인마취화정흡복합마취비교,미체서륜、서분태니화이병분전빙정맥마취대구강악성종류환자면역공능적억제정도교저.
Objective To investigate the effects of different general anesthesia protocols on immune function in patients with oral malignant tumor. Methods Sixty ASA Ⅰ or Ⅱ patients undergoing elective radical operation for oral malignant tumor were randomly divided into 3 groups ( n = 20 each): group Ⅰ total intravenous anesthesia (TIVA); group Ⅱ combined intravenous-inhalational anesthesia (IV-INH) and group Ⅱ inhalational anesthesia (INN). Anesthesia was induced and maintained with propofol and remifentanll in group Ⅰ; with sevoflurane,propofol and remifentanil in group Ⅱ and with sevoflurane and remifentanil in group Ⅲ. Peripheral venous blood samples were taken at 30 min before (To) and 1 h (T1), 3 h (T2 ) and 5 h (T3) after induction of anesthesia, the end of operation (T4 ) and at 24 h (T5 ), 48 h (T6 ) and 72 h (T7) after operation for determination of the percentages of T lymphocyte subsets (CD3+ , CD4+ , CD8+ , CD4+/CD8+ ratio). Natural killer (NK) cells (CD16+ ,CD56+ ) and B lymphocyte (CD19+ ) with flow cytometer. Results The percentages of CD3+ , CD4+ , NK cells, B lymphocyte and CD4+/CD8+ ratio were significantly decreased during and after operation at T1-5 in all groups and the percentges of CD3+ ,CD4+ ,NK cells and CD4+/CD3+ ratio were decreased at T6 in groups Ⅱ and Ⅲ as compared with the baseline values before anesthesia at To. The percentage of CD4+ cells and CD4+/CD8+ratio were significantly lower during anesthesia at T2,3,6 in group Ⅱ than in group Ⅰ . The percentages of CD4 +and NK cells and CD4+/CD8+ ratio were significantly higher after operation at T4,5 in group Ⅱ than in group Ⅲ.The percentages of CD3 + , CD4 + , NK cells and CD4 +/CD8 + ratio were significantly lower at T2-6 in group Ⅲthan in group Ⅰ . Conclusion TIVA with midazolam, propofol and remifentanil has less impact on immune function than inhalational and combined intravenous-inhalational anesthesia in patients with oral malignant tumor under-going elective radical operation.
