Beilin B, Shavit Y, Hart J, Mordashov B, Cohn S, Notti I, Bessler H
Department of Anesthesiology, Rabin Medical Center, Hasharon Hospital, Petah-Tiqva, Israel.
Anesth Analg. 1996 Mar;82(3):492-7. doi: 10.1097/00000539-199603000-00011.
Surgical stress and general anesthesia suppress immune functions, including natural killer cell cytotoxicity (NKCC). This suppression could be attributable, at least in part, to opiates. We have previously shown that large-dose fentanyl administration suppressed NKCC in rats. The present study sought to compare the effects of two anesthetic protocols, based on large- (LDFA) versus small (SDFA)-dose fentanyl anesthesia on NKCC in the perioperative period. Forty patients were included in this study; half were assigned to each protocol of anesthesia. In each anesthetic group, half the patients were undergoing surgery for malignant diseases, and half for benign conditions. Blood samples were collected during the perioperative period. NKCC was assessed using the chromium release assay. Initially, both types of anesthesia similarly suppressed NKCC, with a peak effect 24 h after surgery. The two types of anesthesia, however, differed in the rate of recovery of NKCC suppression. By the second postoperative day, NKCC returned to control values in the SDFA patients, whereas NKCC was still significantly suppressed after LDFA. These results indicate that LDFA causes prolonged suppression of NK cell function. Whether this suppression might have a long-term impact on the overall outcome, especially in cancer patients, remains to be determined.
手术应激和全身麻醉会抑制免疫功能，包括自然杀伤细胞细胞毒性（NKCC）。这种抑制至少部分可归因于阿片类药物。我们之前已表明，给大鼠大剂量注射芬太尼会抑制NKCC。本研究旨在比较两种麻醉方案，即基于大剂量（LDFA）与小剂量（SDFA）芬太尼麻醉对围手术期NKCC的影响。本研究纳入了40例患者；每组麻醉方案各分配一半患者。在每个麻醉组中，一半患者接受恶性疾病手术，另一半接受良性疾病手术。在围手术期采集血样。使用铬释放试验评估NKCC。最初，两种麻醉方式对NKCC的抑制作用相似，术后24小时达到峰值效应。然而，两种麻醉方式在NKCC抑制恢复率方面存在差异。到术后第二天，SDFA组患者的NKCC恢复至对照值，而LDFA组患者的NKCC仍受到显著抑制。这些结果表明，LDFA会导致NK细胞功能的长期抑制。这种抑制是否会对总体结果产生长期影响，尤其是对癌症患者，仍有待确定。
