丙泊酚和七氟烷对腹腔镜结直肠癌根治术患者围手术期免疫功能的影响
병박분화칠불완대복강경결직장암근치술환자위수술기면역공능적영향
The effect of propofol and sevoflurane on the perioperative immunity in patients under laparoscopic radical resection of colorectal cancer
  • 万方数据
    中华医学杂志 중화의학잡지
    National Medical Journal of China
    2015年 42期 3440-3444 ,共5页

    陈亦蛟%梁敏%朱韵甜%周大春

    진역교%량민%주운첨%주대춘

    二异丙酚%七氟烷%围手术期%免疫 二異丙酚%七氟烷%圍手術期%免疫
    이이병분%칠불완%위수술기%면역
    Propofol%Sevoflurane%Perioperation%Immunity
    目的 比较丙泊酚和七氟烷对腹腔镜结直肠癌根治术患者围手术期免疫功能的影响及术后恢复和并发症发生情况.方法 选择浙江大学附属邵逸夫医院2012年9月至2014年4月30例全麻下行腹腔镜结直肠癌根治术的患者,随机分为2组:丙泊酚组和七氟烷组,于麻醉前与术毕即刻、术后24h抽取静脉血检测淋巴细胞亚型,并观察患者术后肠梗阻、尿潴留、吻合口瘘等并发症发生情况,以及切口愈合情况、抗生素使用时间、住院时间等临床预后指标.结果 七氟烷组患者麻醉前CD3+、CD4+、CD19+分别为(59.0±12.0)％、(33.0±8.3)％、(9.9±4.3)％,术毕即刻分别为(64.0±13.5)％、(37.5±11.8)％、(12.3±4.5)％,与麻醉前相比均有升高,差异有统计学意义(t=3.423、2.543、2.768,均P＜0.05),NK细胞麻醉前为(30.7±11.9)％,术毕显著降低为(22.9±13.2)％,差异有统计学意义(t=-3.444,P＜0.01);CD3+、CD19+、NK细胞的变化持续至术后24h,分别为(63.5±9.3)％、(13.0±4.0)％、(22.5±7.2)％,与麻醉前相比差异有统计学意义(t=2.961、3.502、-4.621,均P＜0.05).丙泊酚组患者CD3+、CD4+、CD19+、CD4 +/CD8+比值在麻醉前分别为(61.9±13.6)％、(34.6±8.9)％、(10.4±4.5)％、1.5±0.7,术毕即刻分别为(69.4±9.7)％、(43.2±9.2)％、(15.2±7.4)％、1.9±0.9,较麻醉前均有显著升高(t=4.732、6.132、3.688、4.640,均P＜0.01),NK细胞麻醉前为(27.2±14.3)％,术毕显著下降为(14.7±10.2)％,差异有统计学意义(t=-4.935,P＜0.01);这一变化趋势与七氟烷组一致.术后24 h的CD3+、CD4+、CD4 +/CD8+比值[(63.6±12.3)％、(36.0±8.7)％、1.5±0.6]较术毕即刻下降(t=-2.879、-3.682、-3.340,均P ＜0.05),但与麻醉前比较差异无统计学意义(t=0.858、0.758、-0.074,均P＞0.05);术后24h的NK细胞为(22.2±12.6)％,较术毕即刻回升(t=2.941,P＜0.05),但仍低于麻醉前(t=-2.249,P＜0.05).组间比较,所有指标在3个时刻差异均无统计学意义(均P＞0.05).2组患者术后住院时间、抗生素使用时间、首次排气排便时间、术后发热、切口感染及其他相关并发症(如肠梗阻、尿潴留、吻合口瘘、腹腔感染等)发生率差异均无统计学意义(均P＞0.05).丙泊酚组切口感染率为0,低于七氟烷组的14.3％,虽然差异无统计学意义,但临床意义已经凸显.结论 丙泊酚对免疫细胞功能的影响可能较小,影响时间较短.使用丙泊酚维持麻醉是否更有利于患者术后免疫功能还有待进一步研究.
    목적 비교병박분화칠불완대복강경결직장암근치술환자위수술기면역공능적영향급술후회복화병발증발생정황.방법 선택절강대학부속소일부의원2012년9월지2014년4월30례전마하행복강경결직장암근치술적환자,수궤분위2조:병박분조화칠불완조,우마취전여술필즉각、술후24h추취정맥혈검측림파세포아형,병관찰환자술후장경조、뇨저류、문합구루등병발증발생정황,이급절구유합정황、항생소사용시간、주원시간등림상예후지표.결과 칠불완조환자마취전CD3+、CD4+、CD19+분별위(59.0±12.0)％、(33.0±8.3)％、(9.9±4.3)％,술필즉각분별위(64.0±13.5)％、(37.5±11.8)％、(12.3±4.5)％,여마취전상비균유승고,차이유통계학의의(t=3.423、2.543、2.768,균P＜0.05),NK세포마취전위(30.7±11.9)％,술필현저강저위(22.9±13.2)％,차이유통계학의의(t=-3.444,P＜0.01);CD3+、CD19+、NK세포적변화지속지술후24h,분별위(63.5±9.3)％、(13.0±4.0)％、(22.5±7.2)％,여마취전상비차이유통계학의의(t=2.961、3.502、-4.621,균P＜0.05).병박분조환자CD3+、CD4+、CD19+、CD4 +/CD8+비치재마취전분별위(61.9±13.6)％、(34.6±8.9)％、(10.4±4.5)％、1.5±0.7,술필즉각분별위(69.4±9.7)％、(43.2±9.2)％、(15.2±7.4)％、1.9±0.9,교마취전균유현저승고(t=4.732、6.132、3.688、4.640,균P＜0.01),NK세포마취전위(27.2±14.3)％,술필현저하강위(14.7±10.2)％,차이유통계학의의(t=-4.935,P＜0.01);저일변화추세여칠불완조일치.술후24 h적CD3+、CD4+、CD4 +/CD8+비치[(63.6±12.3)％、(36.0±8.7)％、1.5±0.6]교술필즉각하강(t=-2.879、-3.682、-3.340,균P ＜0.05),단여마취전비교차이무통계학의의(t=0.858、0.758、-0.074,균P＞0.05);술후24h적NK세포위(22.2±12.6)％,교술필즉각회승(t=2.941,P＜0.05),단잉저우마취전(t=-2.249,P＜0.05).조간비교,소유지표재3개시각차이균무통계학의의(균P＞0.05).2조환자술후주원시간、항생소사용시간、수차배기배편시간、술후발열、절구감염급기타상관병발증(여장경조、뇨저류、문합구루、복강감염등)발생솔차이균무통계학의의(균P＞0.05).병박분조절구감염솔위0,저우칠불완조적14.3％,수연차이무통계학의의,단림상의의이경철현.결론 병박분대면역세포공능적영향가능교소,영향시간교단.사용병박분유지마취시부경유리우환자술후면역공능환유대진일보연구.
    Objective To compare the effect of propofol and sevoflurane on perioperative immunity and surgical outcomes in patients undergoing laparoscopic radical resection of colorectal cancer.Methods During September 2012 to April 2014 in Sir Run Run Shaw Hospital,thirty patients scheduled for laparoscopic colorectal cancer radical resection were randomly assigned into two groups:propofol TCI anesthesia and sevofiurane inhale anesthesia.Venous blood was taken before induction,on finishing the surgery and 24 h after surgery for lymphocyte subtype study by flow cytometry.Postoperative outcomes including intestinal obstruction,urine retention,anastomotic fistula and incision healing,antibiotic using time,hospital-stay time were compared.Results In the sevoflurane group,the percentage of CD3+,CD4+ and CD19 + subtype were increased immediately after surgery ((64.0 ± 13.5) ％,(37.5 ± 11.8) ％,(12.3 ± 4.5) ％) comparing to preoperative level ((59.0 ± 12.0) ％,(33.0 ± 8.3) ％,(9.9 ± 4.3) ％) (t =3.423,2.543,2.768 respectively,all P ＜ 0.05),while NK cell percentage was significantly decreased ((22.9±13.2)％ vs (30.7 ± 11.9)％) (t =-3.444,P ＜0.01).The changes of CD3+,CD19+ and NK cell remained significant at24 h ((63.5 ±9.3)％,(13.0 ±4.0)％,(22.5 ±7.2)％) (t =2.961,3.502,-4.621 respectively,all P ＜ 0.05).In the propofol group,the levels of CD3+,CD4 +,CD19 + and CD4 +/CD8 + ratio were significantly increased after surgery ((69.4 ± 9.7) ％,(43.2 ± 9.2) ％,(15.2 ± 7.4) ％,1.9 ± 0.9) comparing to the preoperative levels ((61.9 ± 13.6) ％,(34.6 ±8.9)％,(10.4±4.5)％,1.5 ±0.7) (t=4.732,6.132,3.688,4.640 respectively,allP＜0.01),and NK cell was significantly decreased ((14.7 ± 10.2) ％ vs (27.2 ± 14.3) ％) (t =-4.935,P ＜ 0.01).These changes were similar to that of the sevoflurane group.At 24 h in the propofol group,comparing with those after surgery,CD3+,CD4+ and CD4+/CD8 + ratio were significantly decreased ((63.6 ± 12.3) ％,(36.0 ± 8.7) ％,1.5 ± 0.6) (t =-2.879,-3.682,-3.340 respectively,all P ＜ 0.05),and returned to baseline when comparing to the preoperative level (t =0.858,0.758,-0.074 respectively,all P ＞0.05).NK cell began to recover at 24 h ((22.2 ± 12.6)％) comparing to the postoperative level(t =2.941,P ＜ 0.05),but was still lower than the baseline (t =-2.249,P ＜ 0.05).Also,for all the above data,there were no difference between the two groups at any points (all P ＞ 0.05).There were no difference in hospital-stay time,antibiotic using time,the time to anal exhaust or defecate,postoperative fever,incision infection,neither other complications such as intestinal obstruction,urine retention,anastomotic fistula or intraperitoneal infection (all P ＞ 0.05).The incision infection rate was 0 in the propofol group while 14.3％ in the sevoflurane group,which was quite clinically obvious though not statistically significant.Conclusions Propofol may have less or shorter impact on immunity.However,whether anesthesia with propofol could be superior to that with sevoflurane for patients' immune function is still undetermined and needs further study.
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