Gu Cheng-Yong, Zhang Jin, Qian Yan-Ning, Tang Qi-Feng
Department of Anesthesiology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215008, P.R. China.
Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China.
Mol Clin Oncol. 2015 Jan;3(1):190-196. doi: 10.3892/mco.2014.405. Epub 2014 Sep 1.
Thoracic epidural anesthesia (TEA) has been demonstrated to significantly reduce stress and immune dysfunction in trauma patients. In esophageal carcinoma patients undergoing thoracic surgery, TEA combined with general anesthesia during surgery and subsequent postoperative patient-controlled epidural analgesia (PCEA) may improve plasma cortisol (Cor), interleukin (IL)-6 and IL-17 levels and helper T-cell differentiation. A total of 60 esophageal carcinoma patients undergoing thoracic surgery were randomly allocated into groups I, II, III and I (n=15 per group). During surgery, groups I and II received total intravenous general anesthesia (TIVA), whereas groups III and IV received combined TEA and TIVA. Postoperatively, groups I and III received postoperative patient-controlled intravenous analgesia (PCIA), while groups II and IV received PCEA. The Cor, IL-6, IFN-γ, IL-4 and IL-17 levels were measured in peripheral blood samples collected prior to anesthesia (T0), at 2 h after incision (T1), at 4 h postoperatively (T2), at 24 h postoperatively (T3) and at 48 h postoperatively (T4). The plasma Cor, IL-17 and IL-6 levels increased significantly at the beginning of the operation in groups I, II and III, while in group IV there were no significant differences during the entire period, concurrent with enhanced Th0 to Th2 shift, contributing to a Th2-dominant Th1/Th2 ratio. General anesthesia with TEA more efficiently inhibited the onset of the Th2-dominant status and decreased the plasma levels of Cor and IL-6 compared to general anesthesia alone and PCEA inhibited the Th2-dominant status more efficiently compared to PCIA. Therefore, general anesthesia combined with TEA and sole administration of PCEA were demonstrated to inhibit the stress response and minimize immune dysfunction, generating most pronounced results upon combination TEA/PCEA treatment.
胸段硬膜外麻醉（TEA）已被证明可显著减轻创伤患者的应激反应和免疫功能障碍。在接受胸段手术的食管癌患者中，手术期间TEA联合全身麻醉以及术后患者自控硬膜外镇痛（PCEA）可能会改善血浆皮质醇（Cor）、白细胞介素（IL）-6和IL-17水平以及辅助性T细胞分化。总共60例接受胸段手术的食管癌患者被随机分为I、II、III和IV组（每组n = 15）。手术期间，I组和II组接受全静脉全身麻醉（TIVA），而III组和IV组接受TEA联合TIVA。术后，I组和III组接受术后患者自控静脉镇痛（PCIA），而II组和IV组接受PCEA。在麻醉前（T0）、切口后2小时（T1）、术后4小时（T2）、术后24小时（T3）和术后48小时（T4）采集的外周血样本中测量Cor、IL-6、干扰素-γ（IFN-γ）、IL-4和IL-17水平。I、II和III组在手术开始时血浆Cor、IL-17和IL-6水平显著升高，而IV组在整个期间无显著差异，同时Th0向Th2偏移增强，导致Th1/Th2比值以Th2为主。与单纯全身麻醉相比，TEA联合全身麻醉更有效地抑制了以Th2为主状态的发生，并降低了Cor和IL-6的血浆水平，与PCIA相比，PCEA更有效地抑制了以Th2为主的状态。因此，全身麻醉联合TEA以及单独使用PCEA被证明可抑制应激反应并使免疫功能障碍最小化，在TEA/PCEA联合治疗时产生最显著的效果。
