CAJ | 학술논문

目的：探讨不同麻醉方式对直肠癌根治术患者免疫功能的影响。方法将82例行直肠癌根治术的患者按照数字表法随机分为两组，各41例，A组采用全凭静脉麻醉；B组采用硬膜外阻滞复合静脉全麻。两组分别于麻醉前30 min（T0）、切皮后2 h（T1）、术后2 h（T2）和术后24 h（T3）采外周静脉血检测CD3＋、CD4＋、CD4＋/CD8＋、CD3＋HLA-DR＋和自然杀伤（ NK）细胞的表达情况。结果 A组T2、T3时VAS评分分别为（3．86±0．46）分和（3．62±0．26）分，明显高于B组的（1．67±0．57）分和（1．94±0．42）分（t＝4．624、4．841，均P＜0．05）。 CD3＋、CD4＋、CD4＋/CD8＋、CD3＋HLA-DR＋与NK细胞指标：A组麻醉后各个时点上述指标均低于麻醉前（均P＜0．05）；B组在T1、T2时上述指标均低于麻醉前（均P＜0．05）；而在T3时与麻醉前差异无统计学意义（ P＞0．05）；A组麻醉后各时点上述指标均低于B组（均P＜0．05）。结论硬膜外复合静脉全麻比全凭静脉麻醉对直肠癌患者细胞免疫抑制更轻。
목적：탐토불동마취방식대직장암근치술환자면역공능적영향。방법장82례행직장암근치술적환자안조수자표법수궤분위량조，각41례，A조채용전빙정맥마취；B조채용경막외조체복합정맥전마。량조분별우마취전30 min（T0）、절피후2 h（T1）、술후2 h（T2）화술후24 h（T3）채외주정맥혈검측CD3＋、CD4＋、CD4＋/CD8＋、CD3＋HLA-DR＋화자연살상（ NK）세포적표체정황。결과 A조T2、T3시VAS평분분별위（3．86±0．46）분화（3．62±0．26）분，명현고우B조적（1．67±0．57）분화（1．94±0．42）분（t＝4．624、4．841，균P＜0．05）。 CD3＋、CD4＋、CD4＋/CD8＋、CD3＋HLA-DR＋여NK세포지표：A조마취후각개시점상술지표균저우마취전（균P＜0．05）；B조재T1、T2시상술지표균저우마취전（균P＜0．05）；이재T3시여마취전차이무통계학의의（ P＞0．05）；A조마취후각시점상술지표균저우B조（균P＜0．05）。결론경막외복합정맥전마비전빙정맥마취대직장암환자세포면역억제경경。
Objective To investigate the effects of different anesthesia methods on immunity in patients underwent radical resection of rectal carcinoma.Methods 82 patients underwent radical resection of rectal carcinoma were divided into two groups,each group had 41 cases.A group received total intravenous anesthesia while B group received total intravenous anesthesia combined with eqidural anesthesia.CD3+,CD4+,CD4+/CD8+,CD3+HLA-DR+and NK cells were inspected before induction of anesthesia(T0),2 h after skin incision(T1),2 h(T2) and 24 h(T3) after the end of operation.The T-lymphocyte subsets,activated T cells and NK cells were measured by flow cytometry. Visual analogue scale(VAS) was observed at T2 and T3.Results The VAS score of T2,T3 in A group[(3.86 ± 0.46)points,(3.62 ±0.26)points]were higher than those in B group[(1.67 ±0.57)points,(1.94 ±0.42)points] (all P<0.05).The percentages of CD3+,CD4+,CD4+/CD8+,CD3+HLA-DR+and NK cells of T1,T2,T3 were lower than those of T0 in A group(all P<0.05);The percentages of CD3+,CD4+,CD4+/CD8+,CD3+HLA-DR+and NK cells of T1, T2 were lower than those of T0 in B group ( all P <0.05 );The percentages of CD3+, CD4+, CD4+/CD8+, CD3+HLA-DR+ and NK cells of T1, T2, T3 in A group were lower than those in B group ( all P <0.05 ). Conclusion Total intravenous anesthesia combined with eqidural anesthesia produces less immune suppression than total intravenous anesthesia.