摘要
目的观测不同外科疾病及手术麻醉对外周免疫细胞及血浆阿片肽的影响变化并探讨其意义。方法选取年龄<65岁、ASA分级Ⅰ～Ⅱ级直肠癌患者与髋关节疾病患者各12例,分别在全身麻醉下行腹腔镜直肠癌切除(GA组)或在腰硬联合麻醉下行人工髋关节置换术(CSEA组)。于麻醉开始前、手术开始后1.5 h及手术结束时等时间点测定外周血白细胞(WBC)总数及其分类计数,同时采用ELISA测定血浆中β-内啡肽(EP)、强啡肽(DYN)和脑啡肽(ENK)水平。结果麻醉开始前GA组WBC总数、淋巴细胞(Lym)和单核细胞(Mon)数量显著低于CSEA组(P<0.05)。术中两组的WBC总数降低,尤Lym和Mon显著(P<0.05,P<0.01)。手术结束时两组的WBC总数和中性粒细胞(NE)计数均明显增高,但Lym仍低于基础值水平(P<0.05,P<0.01)。3种阿片肽的血浆水平两组比较虽然差异无统计学意义,但CSEA组EP的基础值显示高于GA组的趋势(P=0.052)。在术中CSEA组的EP显著降低,GA组则显著增高(P<0.01)。CSEA组术中和术毕的DYN和ENK的血浆水平均较基础值显著降低(P<0.05,P<0.01),而GA组无显著改变(P>0.05)。结论髋关节疾病患者的外周免疫细胞及血浆EP基础水平高于直肠癌患者;无论全身麻醉还是腰硬联合麻醉均未能控制手术过程Lym的降低和术毕时的NE增加反应;术毕NE的增加并未使3种内源阿片的血浆水平发生改变。
Objective To evaluate the effects of different surgical diseases and anesthesia on peripheral immune cells and plasma opioid peptide,and thus to explore its implications.Methods Twenty-four cases of rectal cancer or hip joint disease patients（age 65 years and ASA grade Ⅰ-Ⅲ） were selected,on whom laparoscopic colorectal cancer resection under general anesthesia（GA） or total hip replacement under combined spinal-epidural anesthesia（CSEA） were performed,respectively.The peripheral white blood cell（WBC） count and classification,plasma beta-endorphin（EP）,dynorphin（DYN） and enkephalin（ENK） were assessed before anesthesia,1.5 hours after the beginning of operation and at the end of surgery.Results The counts of WBC,Lym and Mon in GA group were significantly lower than those in CSEA group before anesthesia（P 0.05）.The WBC counts in both groups were reduced significantly during surgery,especially the Lym and Mon counts（P 0.05）.At the end of operation,the WBC and NE counts in both groups were significantly higher than baseline（P 0.05）,whereas the Lym counts were still lower（P 0.05）.There was no significant difference in the three plasma opioid peptides between the two groups.The EP level during surgery in CSEA group was significantly reduced,but increased in the GA group（P 0.01）.The DYN and ENK levels were significantly reduced in CSEA group when compared with baseline during and at the end of surgery（P 0.05）,while there was no significant change in the GA group（P 0.05）.Conclusion The basal peripheral immune cell count and plasma EP levels are higher in patients with hip disease than those with rectal cancer.Neither GA nor CSEA could inhibit NE increasing or prevent Lym reduction during surgery.The increase of NE makes no effect on plasma endogenous opioid.
出处
《广东医学》
CAS
CSCD
北大核心
2013年第16期2462-2464,共3页
Guangdong Medical Journal
关键词
外科疾病
麻醉
免疫细胞
阿片肽
surgical diseases
anesthesia
immune cells
opioid peptide
