低流量七氟烷与地氟烷麻醉对中性粒细胞和T细胞群体影响的比较
Comparison of effects of low-flow sevoflurane and desflurane anesthesia on neutrophil and T-cell populations.
作者信息
Pirbudak Cocelli Lutfiye, Ugur Mete Gurol, Karadasli Hakan
机构信息
Department of Anesthesiology, Gaziantep University, Faculty of Medicine, Gaziantep, Turkey.
Department of Obstetrics and Gynaecology, Gaziantep University, Faculty of Medicine, Gaziantep, Turkey.
出版信息
Curr Ther Res Clin Exp. 2012 Feb;73(1-2):41-51. doi: 10.1016/j.curtheres.2012.02.005.
BACKGROUND
Numerous transient effects of anesthesia on postoperative immune status have been documented in the literature.
OBJECTIVE
This study was performed to test the hypothesis that the effects on neutrophil and T-cell populations differ with use of low-flow sevoflurane- and desflurane-induced anesthesia during abdominal surgery.
METHODS
Fifty adult patients (American Society of Anesthesiologists physical status I or II) aged 20 to 60 years were recruited for the study. Patients were randomly assigned to one of two study groups. Anesthesia was induced using fentanyl, propofol, and vecuronium. After intubation, patients in group 1 received sevoflurane, oxygen, and nitrous oxide at a flow rate of 6 L/min, and those in group 2 received desflurane, oxygen, and nitrous oxide at a flow rate of 6 L/min. Ten minutes after induction of anesthesia, the flow rate was decreased to 1 L/min in both groups. Total leukocyte, lymphocyte, and neutrophil counts, percentage of T helper lymphocytes (CD4), cytotoxic T lymphocytes (CD8), natural killer lymphocytes, and active T lymphocyte, CD4/CD8 ratio, and plasma cortisol values were assessed before and at 2 and 24 hours after induction of anesthesia.
RESULTS
In the desflurane group, at 2 hours after induction of anesthesia, a significant decrease was observed in the lymphocyte count, percentage of CD4 cells, and CD4/CD8 ratio, and a significant increase was noted in the neutrophil count and percentage of CD8 cells (P < 0.05). At 24 hours after induction of anesthesia, a significant increase was observed in the leukocyte and neutrophil counts, percentage of CD4 cells, and CD4/CD8 ratio (P < 0.05). There was no change in the other parameters studied. In the sevoflurane group, a significant decrease was observed in the lymphocyte count and percentage of natural killer cells. In addition, a significant increase was noted in the leukocyte and neutrophil counts at 24 hours after induction of anesthesia (P < 0.01). The increase in the neutrophil count in the desflurane group compared with that in the sevoflurane group was statistically significant (P < 0.05).
CONCLUSIONS
With use of the low-flow anesthesia technique, compared with desflurane, sevoflurane exerts minimal effects on neutrophil and T-cell populations, which supports our hypothesis.
背景
麻醉对术后免疫状态的众多短暂影响已在文献中得到记载。
目的
本研究旨在验证以下假设：在腹部手术期间，低流量七氟烷和地氟烷诱导麻醉对中性粒细胞和T细胞群体的影响存在差异。
方法
招募50例年龄在20至60岁之间的成年患者（美国麻醉医师协会身体状况I或II级）进行研究。患者被随机分配到两个研究组之一。使用芬太尼、丙泊酚和维库溴铵诱导麻醉。插管后，第1组患者以6 L/min的流速接受七氟烷、氧气和氧化亚氮，第2组患者以6 L/min的流速接受地氟烷、氧气和氧化亚氮。麻醉诱导10分钟后，两组的流速均降至1 L/min。在麻醉诱导前、诱导后2小时和24小时评估总白细胞、淋巴细胞和中性粒细胞计数、辅助性T淋巴细胞（CD4）百分比、细胞毒性T淋巴细胞（CD8）、自然杀伤淋巴细胞和活性T淋巴细胞、CD4/CD8比值以及血浆皮质醇值。
结果
在地氟烷组，麻醉诱导后2小时，观察到淋巴细胞计数、CD4细胞百分比和CD4/CD8比值显著降低，中性粒细胞计数和CD8细胞百分比显著增加（P < 0.05）。麻醉诱导后24小时，观察到白细胞和中性粒细胞计数、CD4细胞百分比和CD4/CD8比值显著增加（P < 0.05）。所研究的其他参数无变化。在七氟烷组，观察到淋巴细胞计数和自然杀伤细胞百分比显著降低。此外，麻醉诱导后24小时白细胞和中性粒细胞计数显著增加（P < 0.01）。地氟烷组中性粒细胞计数的增加与七氟烷组相比具有统计学意义（P < 0.05）。
结论
使用低流量麻醉技术时，与地氟烷相比，七氟烷对中性粒细胞和T细胞群体的影响最小，这支持了我们的假设。
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