不同麻醉和术后镇痛方法对大鼠原位肝癌切除术后辅助性T淋巴细胞免疫功能和肿瘤转移影响的比较
불동마취화술후진통방법대대서원위간암절제술후보조성T림파세포면역공능화종류전이영향적비교
Comparison of effects of different anesthetic and postoperative analgesic methods on immune function of helper T lymphocytes and tumor metastasis after orthotopic liver cancer resection in rats
  • 万方数据
    中华麻醉学杂志 중화마취학잡지
    CHINESE JOURNAL OF ANESTHESIOLOGY
    2014年 1期 19-23 ,共5页

    周荻%朱兰芳%缪长虹

    주적%주란방%무장홍

    麻醉,全身%麻醉,硬膜外%镇痛%肝肿瘤%肝切除术%CD4阳性T淋巴细胞%免疫,细胞%肿瘤转移 痳醉,全身%痳醉,硬膜外%鎮痛%肝腫瘤%肝切除術%CD4暘性T淋巴細胞%免疫,細胞%腫瘤轉移
    마취,전신%마취,경막외%진통%간종류%간절제술%CD4양성T림파세포%면역,세포%종류전이
    Anesthesia,general%Anesthesia,epidural%Analgesia%Liver neoplasms%Hepatectomy%CD4-positive T-lymphocytes%Immunity,cellular%Neoplasm metastasis
    目的 比较不同麻醉和术后镇痛方法对大鼠原位肝癌切除术后辅助性T淋巴细胞免疫功能和肿瘤转移的影响.方法 采用肝包膜下植入肿瘤(肝细胞肝癌)组织建立大鼠原位肝癌模型.取雄性原位肝癌ACI大鼠30只,12～ 18周龄,体重240 ～ 300 g,采用随机数字表法,将其分为3组(n=10):对照组(C组)、全麻联合硬膜外阻滞-术后硬膜外镇痛组(GE+ EA组)和全麻-术后静脉镇痛组(G+ IA组).肿瘤组织植入后第14天行肝癌切除术,G+ IA组吸入5％七氟醚麻醉诱导,吸入2％ ～ 3％七氟醚,腹腔注射吗啡20 μg/100 g维持麻醉；GE+ EA组全麻(方法同G组)气管插管成功后,经硬膜外注射0.25％布比卡因25 μl行硬膜外阻滞.术后3d内进行术后镇痛:GE+ EA组每天经硬膜外导管注入0.125％布比卡因150μl+吗啡20μg,每4h注射1次,每次25 μl;G+ IA组每天腹腔注射吗啡240 μg,每4h注射1次,每次40 μg.GE+ EA组和G+ IA组于术前(T1)、术后第2天(T2)、第7天(T3)和第30天(T4)时,C组于相应时点取血样,采用ELISA法检测血浆干扰素-γ(IFN-γ)、IL-4、IL-17、IL-10和转化生长因子-β1(TGF-β1)的浓度,并计算IFN-γ/IL-4比值.T4时取血后,处死大鼠,记录腹腔淋巴结转移、癌性腹水和腹壁种植及肉眼可见的肺转移结节等发生情况.结果 与C组相比,G+ IA组肺转移灶、腹腔淋巴结转移和癌性腹水发生率降低,T2时血浆IFN-γ和IL-17浓度升高,T2,3时血浆IL-4、TGF-β1浓度升高,IFN-γ/IL-4比值降低,GE+ EA组肺转移灶、腹腔淋巴结转移、癌性腹水和腹壁种植发生率降低,T2时血浆IFN-γ、IL-4、IL-17、IL-10、TGF-β1浓度升高(P＜0.05),IFN-γ/IL-4比值差异无统计学意义(P＞0.05)；与G+ IA组相比,GE+ EA组肺转移灶、腹腔淋巴结转移发生率降低,T2时血浆IFN-γ、IL-17浓度、T3时血浆IL-4、IL-10浓度降低,T4时血浆IFN-γ浓度、T2时血浆TGF-β1浓度、T3,4时IFN-γ/IL-4比值升高(P＜0.05).结论 与全麻-术后静脉镇痛比较,全麻联合硬膜外阻滞-术后硬膜外镇痛对原位肝癌切除术大鼠术后辅助性T淋巴细胞免疫功能的抑制程度降低,肿瘤转移几率降低.
    목적 비교불동마취화술후진통방법대대서원위간암절제술후보조성T림파세포면역공능화종류전이적영향.방법 채용간포막하식입종류(간세포간암)조직건립대서원위간암모형.취웅성원위간암ACI대서30지,12～ 18주령,체중240 ～ 300 g,채용수궤수자표법,장기분위3조(n=10):대조조(C조)、전마연합경막외조체-술후경막외진통조(GE+ EA조)화전마-술후정맥진통조(G+ IA조).종류조직식입후제14천행간암절제술,G+ IA조흡입5％칠불미마취유도,흡입2％ ～ 3％칠불미,복강주사마배20 μg/100 g유지마취；GE+ EA조전마(방법동G조)기관삽관성공후,경경막외주사0.25％포비잡인25 μl행경막외조체.술후3d내진행술후진통:GE+ EA조매천경경막외도관주입0.125％포비잡인150μl+마배20μg,매4h주사1차,매차25 μl;G+ IA조매천복강주사마배240 μg,매4h주사1차,매차40 μg.GE+ EA조화G+ IA조우술전(T1)、술후제2천(T2)、제7천(T3)화제30천(T4)시,C조우상응시점취혈양,채용ELISA법검측혈장간우소-γ(IFN-γ)、IL-4、IL-17、IL-10화전화생장인자-β1(TGF-β1)적농도,병계산IFN-γ/IL-4비치.T4시취혈후,처사대서,기록복강림파결전이、암성복수화복벽충식급육안가견적폐전이결절등발생정황.결과 여C조상비,G+ IA조폐전이조、복강림파결전이화암성복수발생솔강저,T2시혈장IFN-γ화IL-17농도승고,T2,3시혈장IL-4、TGF-β1농도승고,IFN-γ/IL-4비치강저,GE+ EA조폐전이조、복강림파결전이、암성복수화복벽충식발생솔강저,T2시혈장IFN-γ、IL-4、IL-17、IL-10、TGF-β1농도승고(P＜0.05),IFN-γ/IL-4비치차이무통계학의의(P＞0.05)；여G+ IA조상비,GE+ EA조폐전이조、복강림파결전이발생솔강저,T2시혈장IFN-γ、IL-17농도、T3시혈장IL-4、IL-10농도강저,T4시혈장IFN-γ농도、T2시혈장TGF-β1농도、T3,4시IFN-γ/IL-4비치승고(P＜0.05).결론 여전마-술후정맥진통비교,전마연합경막외조체-술후경막외진통대원위간암절제술대서술후보조성T림파세포면역공능적억제정도강저,종류전이궤솔강저.
    Objective To compare the effects of different anesthetic and postoperative analgesic methods on the immune function of helper T lymphocytes and tumor metastasis after orthotopic liver cancer resection in rats.Methods Orthotopic liver cancer was induced by intrahepatic tumor implantation (IHTI) with Morris hepatoma 3924A.Thirty male ACI rats receiving IHTI,aged 12-18 weeks,weighing 240-300 g,were randomized into 3 groups (n =10 each) using a random number table:control group (group C),general anesthesia combined with epidural block-postoperative epidural analgesia group (group GE + EA),and general anesthesia-postoperative intravenous analgesia group (group G + IA).The liver cancer resection was performed on 14th day after IHTI,group G + IA inhaled 5％ sevoflurane for induction of anesthesia and inhaled 2％-3％ sevoflurane and received intraperitoneal injection of morphine 20 μg/100 g for maintenance of anesthesia.In group GE + EA,general anesthesia was performed as the method previously described in group G + IA,and epidural block was performed with 0.25 ％ bupivacaine 25 μl after tracheal intubation.Within 3 days after operation,0.125 ％ bupivacaine 150 μl + morphine 20 μg were injected daily via an epidural catheter once every 4 h (25μl per time) for postoperative analgesia in group GE + EA,and postoperative analgesia was performed with intraperitoneal morphine 240 μg injected daily once every 4 h (40 μg per time) in group G+ IA.Before surgery (T1) and on 2nd,7th and 30th days after sugery (T2-4),blood samples were collected to detect the levels of plasma interferon-γ (IFN-γ),interleukin-4 (IL-4),IL-17,IL-10 and tumor growth factor-β1 (TGF-β1).IFN-γ/IL-4 ratio was calculated.The rats were sacrificed after collecting blood samples at T4,and the development of abdominal lymph node metastasis,malignant ascites,implantation metastasis to abdominal wall and visible pulmonary metastasis nodules were observed.Results Compared with C group,the incidence of pulmonary metastasis,abdominal lymph node metastasis,and malignant ascites was significantly decreased,the plasma IFN-γ and IL-17 levels at T2 and IL-4 and TGF-β at T2,3 were increased,and IFN-γ/IL-4 ratio was decreased at T2,3 in group G+ IA,and the incidence of pulmonary metastasis,abdominal lymph node metastasis,malignant ascites and implantation metastasis to abdominal wall was significantly decreased,the plasma levels of IFN-γ,IL-4,IL-17,IL-10 and TGF-β1 were increased at T2(P ＜ 0.05),and no significant change was found in IFN-γ/IL-4 ratio in GE + EA group (P ＞ 0.05).Compared with G + IA group,the incidence of pulmonary metastasis and abdominal lymph node metastasis was significantly decreased,the plasma levels of IFN-γ and IL-17 at T2 and IL-4 and IL-10 at T3 were decreased,the plasma levels of IFN-γ at T4 and TGF-β1 at T2 and IFN-γ/IL-4 ratio at T3,4 were increased in GE + EA group (P ＜ 0.05).Conclusion The inhibitory degree of the immune function of helper T lymphocytes is decreased and development of tumor metastasis is reduced after orthotopic liver cancer resection in rats when general anesthesia combined with epidural block-postoperative epidural analgesia is applied as compared with those when general anesthesia-postoperative intravenous analgesia is applied.
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