不同麻醉方法及麻醉深度对胃癌手术患者细胞免疫功能影响.docVIP

不同麻醉方法及麻醉深度对胃癌手术患者细胞免疫功能影响 　【摘要】 目的: 探讨不同麻醉方法及麻醉深度对胃癌手术患者细胞免疫功能的影响,为临床手术采取合理的麻醉方法提供科学根据。方法：将80例胃癌手术患者随机分成静吸复合麻醉组（A组）和单纯静脉麻醉组（B组），每组40例，组内再各分为深麻醉组（AH组,BH组）和浅麻醉组（AL组,BL组）。深麻醉组和浅麻醉组脑电双频指数（bispectral index，BIS）分别为35～50和55～68。两组分别于麻醉前、术毕及术后72 h检测外周血T淋巴细胞亚群及NK细胞数量。结果:术毕各组CD3+ 、 CD4+ 、CD4+/CD8+ 及NK细胞数量均较麻醉前下降（Plt;0.05）,同种麻醉方法AL组、BL组较AH组、BH组下降明显（Plt;0.05）；术后72 h各组各项指标均恢复至麻醉前水平；在相同时段不同麻醉方法深、浅麻醉组之间各指标差异无统计学意义（Pgt;0.05）。结论： 静吸复合麻醉与单纯静脉麻醉均可影响患者的细胞免疫功能，但深麻醉状态较浅麻醉状态影响小，可能与患者应激反应有关。 【关键词】 麻醉，全身·麻醉，吸入·麻醉，静脉内·胃肿瘤·T淋巴细胞·杀伤细胞，天然 【ABSTRACT】 Objective: To study the effects of different anesthesia methods and anesthesia depth on postoperative changes in T-lymphocyte subsets and NK cells in the patients undergoing operation of stomach carcinoma. Methods: Eighty patients with stomach carcinoma were randomly divided into two groups. The patients in group A received intravenous-inhalation anesthesia and those in group B total intravenous anesthesia. Those patients of each group were divided into adequate anesthesia group (group AH, group BH) and inadequate anesthesia group (group AL, group BL).In group AH and group BH bispectral index (BIS) was between 35 and 50, 55 and 68 in group AL and group BL. Peripheral venous blood sample were taken before anesthesia, at the end of operation, and at 72h after operation for determination of T-lymphocyte subsets CD3+,CD4+,CD4+/CD8+ and NK cells by flow cytometer. Results: CD3+, CD4+, CD4+/CD8+ and NK cells decreased at the end of operation in all groups compared with those before anesthesia (Plt;0.05). At 72h after operation, the values increased to the level before anesthesia in all groups. The values significantly decreased at the end of operation in group AL and group BL than in group AH and group BH(Plt;0.05). The differences of those values between group AH and group BH were no statistical significance, neither between group AL and group BL (Pgt;0.05). Conclusions: General anesthesia has transient inhibitory effects on cellular immune function in