Zhang T, Fan Y, Liu K, Wang Y
Department of Anesthesiology and The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory for Oral Biomedicine, Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
Anaesth Intensive Care. 2014 Mar;42(2):220-7. doi: 10.1177/0310057X1404200209.
The aim of this study was to investigate the effects of different general anaesthesia techniques on immune responses in patients undergoing surgery for tongue cancer. Sixty American Society of Anesthesiologists physical status 1 or 2 patients undergoing elective reconstructive surgery for tongue cancer were randomised to three groups. Group 1 received propofol induction and maintenance (TIVA), group 2 received propofol induction and sevoflurane maintenance (MIXED) and group 3 received sevoflurane induction and maintenance (SEVO). All patients received an infusion of remifentanil. Blood samples were obtained at eight time-points: 30 minutes before induction (T0); one hour (T1), three hours (T2) and five hours (T3) after induction; at the end of the operation (T4); and 24 hours (T5), 48 hours (T6) and 72 hours (T7) after operation. The T lymphocyte subsets (including CD3(+) cells, CD3(+)CD4(+) cells and CD3(+)CD8(+)cells) and CD4(+)/CD8(+) ratio, natural killer cells and B lymphocytes were analysed by flow cytometry. All immunological indicators except CD3(+)CD8(+) cells were significantly decreased in all groups at T1~T5 compared to T0 (P <0.05). The percentages of CD3(+) cells, CD3(+)CD4(+) cells and natural killer cells, and the CD4(+)/CD8(+) ratios were significantly lower in the MIXED groups and SEVO groups but not the TIVA group at T6 as compared with T0 (P <0.05). There were minor but statistically significant differences in the percentages of CD3(+) cells, CD3(+)CD4(+) cells and natural killer cells, and the CD4(+)/CD8(+) ratios between the SEVO group and the TIVA group at T2approxT6 (P <0.05). These findings suggest that propofol has slightly less effect on cellular immune responses than sevoflurane.
本研究旨在探讨不同全身麻醉技术对舌癌手术患者免疫反应的影响。60例美国麻醉医师协会身体状况为1或2级的择期舌癌重建手术患者被随机分为三组。第1组接受丙泊酚诱导和维持（全凭静脉麻醉），第2组接受丙泊酚诱导和七氟醚维持（复合麻醉），第3组接受七氟醚诱导和维持（七氟醚麻醉）。所有患者均输注瑞芬太尼。在八个时间点采集血样：诱导前30分钟（T0）；诱导后1小时（T1）、3小时（T2）和5小时（T3）；手术结束时（T4）；以及术后24小时（T5）、48小时（T6）和72小时（T7）。通过流式细胞术分析T淋巴细胞亚群（包括CD3(+)细胞、CD3(+)CD4(+)细胞和CD3(+)CD8(+)细胞）以及CD4(+)/CD8(+)比值、自然杀伤细胞和B淋巴细胞。与T0相比，所有组在T1~T5时除CD3(+)CD8(+)细胞外的所有免疫指标均显著降低（P<0.05）。与T0相比，复合麻醉组和七氟醚麻醉组在T6时CD3(+)细胞、CD3(+)CD4(+)细胞和自然杀伤细胞的百分比以及CD4(+)/CD8(+)比值显著降低，但全凭静脉麻醉组未降低（P<0.05）。在T2至T6时，七氟醚麻醉组和全凭静脉麻醉组之间CD3(+)细胞、CD3(+)CD4(+)细胞和自然杀伤细胞的百分比以及CD4(+)/CD8(+)比值存在微小但具有统计学意义的差异（P<0.05）。这些发现表明，丙泊酚对细胞免疫反应的影响略小于七氟醚。
