不同的麻醉与镇痛方式对危重症患者免疫功能和血清肿瘤标记物含量的影响
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Effects of different methods of anesthesia and analgesia on immune function and serum tumor marker levels in critically ill patients
背景与目的
探究不同的麻醉与镇痛方式对肿瘤切除术患者免疫功能和血清肿瘤标记物含量的影响。
方 法
本研究纳入郑州大学第二附属医院2015年9月-2016年8月期间择期行肿瘤切除术的患者76名，随机分为对照组和观察组（n=38），其中对照组采用全身麻醉和术后静脉麻醉药物镇痛，观察组采用全身麻醉联合硬膜外麻醉以及术后硬膜外麻醉镇痛。分别采集麻醉前30min（T1）、手术2h（T2）、手术结束即刻（T3）、术后24h（T4）以及后72h（T5）时点的静脉血，应用流式细胞计数检测T淋巴细胞亚型（CD3+,CD4+,CD8+,CD4+/CD8+）和自然杀伤（NK）细胞的活细胞比例，免疫荧光技术检测术前术后24h时的癌胚抗原，糖链抗原199，糖链抗原125，神经元特异性烯醇化酶以及细胞角蛋白19的含量。
结 果
对照组CD3+,CD4+,CD8+,CD4+/CD8+的含量T3-T5时点低于T1时点（P＜0.05）。虽然观察组CD3+的含量T3时点同样低于T1时点，但T4和T5时点与T1时点的无显著差异（P＜0.05）。T2-T5时点观察组CD3+,CD4+,CD8+,CD4+/CD8+的含量显著高于对照组，T4时点观察组CD3+,CD4+的含量显著高于对照组，T5时点观察组CD4+/CD8+的含量显著高于对照组（P＜0.05）。两组患者不同时点的CD8+细胞和NK细胞含量以及术后24h时的肿瘤标记物含量并无显著差异。
结 论
本研究的结果显示，尽管两组患者不同时点的肿瘤标记物含量无差异，但采用全身麻醉联合硬膜外麻醉和术后硬膜外麻醉镇痛方式比采用全身麻醉和术后静脉麻醉药物镇痛方式对肿瘤切除术患者的免疫功能影响更小。
原始文献摘要
Song P, Dong T, Zhang J, et al. Effects of different methods of anesthesia and analgesia on immune function and serum tumor marker levels in critically ill patients.[J]. Experimental and therapeutic medicine, 2017,14(3):2206-2210. DOI:10.3892/etm.2017.4762.
Abstract：
This study investigated the effects of different anesthesia and analgesia methods on immune function and serum tumor marker levels of critically ill patients undergoing tumor resection surgery. Seventy-six critically ill patients with indications for tumor resection surgery were selected in The Second Affiliated Hospital of Zhengzhou University from September 2015 to August 2016. The patients were randomly divided into a control and an observation group (38 patients each). The patients in the control group were treated with general anesthesia and postoperative intravenous analgesia, while the patients in the observation group were treated with general anesthesia and epidural anesthesia and postoperative epidural analgesia. Venous blood samples were collected at 30 min before anesthesia (T1), 2 h after the beginning of the surgery (T2), immediately after surgery (T3), 24 h after surgery (T4) and 72 h after surgery (T5). The viable cell percentage of T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) and natural killer (NK) cells were measured by flow cytometry. The levels of carcinoembryonic antigen, sugar chain antigen 199, sugar chain antigen 125, neuron specific enolase and cytokeratin 19 were detected by electrochemiluminescence at 24 h before and after operation. Our results showed the levels of CD3+, CD4+ and CD4+/CD8+ in the control group at T3-T5 were significantly lower than those at T1 (p<0.05). The CD3+ level in observation group at T3 was also significantly lower than the level at T1 (p<0.05), but it increased at T4 and T5 and showed no significant difference compared with the initial level (p>0.05). The levels of CD4+ and CD4+/CD8+ in the observation group were significantly higher than those in the control group at T2-T5 (p<0.05). And, the levels of CD3+ and CD4+ were significantly higher than those in the control group at T4 (p<0.05). The level of CD4+/CD8+ was significantly higher than that in the control group at T5 (p<0.05). No significant differences were found in the levels of CD8+ and NK cells between the 2 groups at any of the time-points (p>0.05). No significant differences were found either in any of the tested tumor markers in either group after 24 h. Even without differences on the tumor marker levels, these results suggest that general anesthesia combined with epidural anesthesia and analgesia produces milder deleterious effects on the immune function of perioperative critically ill patients than general anesthesia combined with intravenous analgesia.
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