Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
J Clin Anesth. 2013 Jun;25(4):255-62. doi: 10.1016/j.jclinane.2012.12.007. Epub 2013 May 7.
To assess preoperative and postoperative immune function in patients undergoing surgical resection of non-small cell lung cancer during general anesthesia and postoperative epidural analgesia.
Observational single-center study.
University-affiliated academic center.
24 adult, ASA physical status 3 and 4 patients with stage 1, 2, or 3 non-small cell lung cancer. No study patient received preoperative chemotherapy or radiation.
Patients underwent thoracotomy with general anesthesia and postoperative epidural analgesia.
Bispectral index monitoring, sevoflurane requirements, and intraoperative transfusions were recorded. Total fentanyl consumption and pain (verbal numeric rating scale) were recorded 24 hours after surgery. Preoperative and 24-hour postoperative natural killer cell percentage and function and percentages of natural killer T cells, T helper cells (CD4+), and cytotoxic T lymphocytes (CD8+) were measured. Plasma concentrations of the TH1 cytokine interleukin-2 and interferon-gamma and the TH2 cytokines interleukin-4 were measured at the same time points.
The percentage (preoperative, 13.07 ± 9.81% vs postoperative, 9.6 ± 6.57%, P < 0.001) and function (preoperative, 31.61 ± 21.96%; postoperative, 13.61 ± 9.36%; P < 0.001) of natural killer cells was significantly decreased after surgery, but the percentage of natural killer T cells, T helper cells (CD4+), and cytotoxic T lymphocytes (CD8+) remained unchanged postoperatively; thus, the CD4/CD8 ratio remained unchanged. Postoperative plasma concentrations of the three cytokines were similar to preoperative levels; therefore, the TH1/TH2 ratio also remained unchanged.
Innate immunity is depressed in patients with non-small cell lung cancer after surgical resection, and immunity is not preserved by the use of postoperative epidural analgesia.
评估非小细胞肺癌患者在全身麻醉和术后硬膜外镇痛下行外科切除术的围手术期免疫功能。
观察性单中心研究。
大学附属学术中心。
24 名成年 ASA 身体状况 3 级和 4 级的Ⅰ、Ⅱ或Ⅲ期非小细胞肺癌患者。无研究患者接受术前化疗或放疗。
患者接受全身麻醉下的开胸术和术后硬膜外镇痛。
记录脑电双频指数监测、七氟醚需求和术中输血。记录术后 24 小时的总芬太尼消耗量和疼痛（数字评分量表）。测量术前和术后 24 小时自然杀伤细胞百分比和功能以及自然杀伤 T 细胞、辅助性 T 细胞（CD4+）和细胞毒性 T 淋巴细胞（CD8+）的百分比。同时测量 TH1 细胞因子白细胞介素-2 和干扰素-γ和 TH2 细胞因子白细胞介素-4 的血浆浓度。
手术后自然杀伤细胞的百分比（术前 13.07±9.81%，术后 9.6±6.57%，P<0.001）和功能（术前 31.61±21.96%，术后 13.61±9.36%，P<0.001）显著降低，但自然杀伤 T 细胞、辅助性 T 细胞（CD4+）和细胞毒性 T 淋巴细胞（CD8+）的百分比术后无变化；因此，CD4/CD8 比值无变化。术后三种细胞因子的血浆浓度与术前水平相似；因此，TH1/TH2 比值也保持不变。
非小细胞肺癌患者手术后固有免疫功能受到抑制，术后硬膜外镇痛不能保留免疫力。
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