低中心静脉压对肝癌手术患者围术期免疫功能的影响
发布时间：2018-11-02 08:17
【摘要】：目的:探讨低中心静脉压(Low central venous pressure,LCVP)对肝癌手术患者围术期免疫功能的影响。方法:采用前瞻性研究方法,选择2016年10月至2017年1月我院收治的术前确诊为肝细胞肝癌并择期行肝叶部分切除术的患者40例。按照随机数字法分为对照组(P组:传统液体管理方法,CVP维持在6-12cmH2O)和控制性降CVP组(C组:限制液体输入速度,肝门阻断期间将CVP维持在3-5cmH2O),每组20例。两组均采取相同的麻醉和手术方案,于诱导前3min(T1)、诱导后3min(T2)、肝门阻断前3min或控制性降CVP前3min(T3)、肝叶切除后3min(T4)、手术结束时(T5)和术后24h(T6)六个时间点记录患者血流动力学情况,手术结束时记录患者的输液量、出血量、尿量及输血量,并抽取中心静脉血2.0 m L离心取血清低温存放,采用酶联免疫吸附试验检测患者六个时间点血清白介素(IL)-4、干扰素(IFN)-γ和转录生长因子(TGF)-β1的浓度。常规检测患者术前、术后第三天的肝转氨酶ALT、AST水平及免疫功能指标。结果:两组血流动力学变化:于T4时间点,C组心率高于P组,差异有统计学意义(P0.05);C组平均动脉压低于P组,差异有统计学意义(P0.05),但均在正常数值范围内波动,术中其他时间点比较差异无统计学意义(均P0.05)。两组液体管理比较:C组输液总量、失血总量、输血总量和尿量均比P组减少,差异有统计学意义(均P0.05)。两组ALT和AST的变化:两组患者术前和术后第三天ALT和AST数值比较,差异无统计学意义(均P0.05);但两组患者术后第3 d的ALT和AST均明显较术前基础值升高(均P0.05)。两组免疫功能变化:C、P两组体液免疫IgG、IgM和IgA术后3天与术前比较均明显降低,差异有统计学意义(均P0.05),C、P两组间IgG、IgM、IgA水平比较,差异无统计学意义(均P0.05)。两组术后第3天与术前CD3+、CD3+CD4+、CD3+CD8+、CD19+数值比较,差异均无统计学意义(均P0.05);术后第三天P组、C组CD3-CD16+CD56+与术前比较均显著下降,差异有统计学意义(均P0.05),而P组术后第3天CD3-CD16+CD56+较C组明显降低,差异有统计学意义(P0.05);C组术后第3天CD3+CD4+/CD3+CD8+较术前增高,差异有统计学意义(P0.05)。两组细胞因子变化:IL-4:C组T4、T5时间点IL-4水平较T1时间点明显降低,P组T6时间点IL-4水平明显较各时间点明显降低,差异有统计学意义(均P0.05);P、C两组比较,C组T5时间点IL-4表达水平明显低于P组,差异有统计学意义(P0.05);P组T6时间点IFN-γ表达水平明显较T2、T3和T4时间点升高(均P0.05),其余时间点比较差异无统计学意义(均P0.05)。TGF-β1组内、组间比较,差异均无统计学意义(均P0.05)结论:低中心静脉压组IL-4的变化更明显;低中心静脉压组对免疫功能有保护作用。
[Abstract]:Objective: to investigate the effect of low central venous pressure (Low central venous pressure,LCVP) on perioperative immune function in patients with liver cancer. Methods: a prospective study was carried out in 40 patients with hepatocellular carcinoma (HCC) diagnosed preoperatively and underwent partial hepatectomy from October 2016 to January 2017. According to the random number method, the patients were divided into two groups: control group (P group: traditional liquid management method, CVP maintained in 6-12cmH2O) and controlled descending CVP group (C group: limiting fluid input velocity, maintaining CVP at 3-5cmH2O during hepatic portal occlusion), 20 cases in each group. The two groups were given the same anesthesia and operation. Before induction 3min (T 1), after induction 3min (T 2), before hepatic hilus occlusion or before controlled CVP 3min (T 3), after hepatectomy 3min (T 4). Hemodynamics was recorded at the end of operation (T5) and 24 hours after operation (T6). Transfusion volume, blood loss, urine volume and blood transfusion were recorded at the end of operation. The concentration of serum interleukin (IL)-4, interferon (IFN)-纬 and transcription growth factor (TGF)-尾 1 were detected by enzyme linked immunosorbent assay (Elisa). The level of hepatic transaminase (ALT,AST) and immune function were measured before and after operation. Results: the changes of hemodynamics in two groups: at T4 time point, heart rate in group C was higher than that in group P, the difference was statistically significant (P0.05). The mean arterial depression in group C was significantly lower than that in group P (P0.05), but all fluctuated within the normal range of values, and there was no significant difference in other time points during operation (P0.05). Comparison of two groups of liquid management: C group total infusion, total blood loss, total blood transfusion and urine volume were lower than P group, the difference was statistically significant (P0.05). The changes of ALT and AST in the two groups: there was no significant difference in ALT and AST between the two groups before operation and on the third day after operation (P0.05), but the ALT and AST of the two groups on the 3rd day after operation were significantly higher than those of the preoperative basic value (P0.05). The changes of immune function in the two groups: the humoral immune IgG,IgM and IgA were significantly decreased 3 days after operation (P0.05), and the level of IgG,IgM,IgA was higher than that of the control group (P0.05). The difference was not statistically significant (P0.05). There was no significant difference in CD3, CD3 CD4, CD3 CD8, CD19 between the two groups on the 3rd day after operation (P0.05). On the third day after operation, CD3-CD16 CD56 in group P and group C were significantly decreased compared with those before operation (P0.05), while CD3-CD16 CD56 in group P was significantly lower than that in group C on the third day after operation (P0.05). The ratio of CD3 CD4 / CD3 CD8 in group C was significantly higher than that before operation on the 3rd day after operation (P0.05). The changes of cytokines in two groups: the level of IL-4 in IL-4:C group was significantly lower than that at T1 time point, and the IL-4 level at T6 time point in P group was significantly lower than that at each time point (P0.05). The expression of IL-4 in group C was significantly lower than that in group P at T5 time point (P0.05). The expression of IFN- 纬 at T6 time point in P group was significantly higher than that at T 2 T 3 and T 4 time points (P0.05), but there was no significant difference in other time points (P 0.05). There was no significant difference (P0.05) conclusion: the change of IL-4 was more obvious in low central venous pressure group. Low central venous pressure group had protective effect on immune function.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614;R735.7
本文编号：2305455
[Abstract]:Objective: to investigate the effect of low central venous pressure (Low central venous pressure,LCVP) on perioperative immune function in patients with liver cancer. Methods: a prospective study was carried out in 40 patients with hepatocellular carcinoma (HCC) diagnosed preoperatively and underwent partial hepatectomy from October 2016 to January 2017. According to the random number method, the patients were divided into two groups: control group (P group: traditional liquid management method, CVP maintained in 6-12cmH2O) and controlled descending CVP group (C group: limiting fluid input velocity, maintaining CVP at 3-5cmH2O during hepatic portal occlusion), 20 cases in each group. The two groups were given the same anesthesia and operation. Before induction 3min (T 1), after induction 3min (T 2), before hepatic hilus occlusion or before controlled CVP 3min (T 3), after hepatectomy 3min (T 4). Hemodynamics was recorded at the end of operation (T5) and 24 hours after operation (T6). Transfusion volume, blood loss, urine volume and blood transfusion were recorded at the end of operation. The concentration of serum interleukin (IL)-4, interferon (IFN)-纬 and transcription growth factor (TGF)-尾 1 were detected by enzyme linked immunosorbent assay (Elisa). The level of hepatic transaminase (ALT,AST) and immune function were measured before and after operation. Results: the changes of hemodynamics in two groups: at T4 time point, heart rate in group C was higher than that in group P, the difference was statistically significant (P0.05). The mean arterial depression in group C was significantly lower than that in group P (P0.05), but all fluctuated within the normal range of values, and there was no significant difference in other time points during operation (P0.05). Comparison of two groups of liquid management: C group total infusion, total blood loss, total blood transfusion and urine volume were lower than P group, the difference was statistically significant (P0.05). The changes of ALT and AST in the two groups: there was no significant difference in ALT and AST between the two groups before operation and on the third day after operation (P0.05), but the ALT and AST of the two groups on the 3rd day after operation were significantly higher than those of the preoperative basic value (P0.05). The changes of immune function in the two groups: the humoral immune IgG,IgM and IgA were significantly decreased 3 days after operation (P0.05), and the level of IgG,IgM,IgA was higher than that of the control group (P0.05). The difference was not statistically significant (P0.05). There was no significant difference in CD3, CD3 CD4, CD3 CD8, CD19 between the two groups on the 3rd day after operation (P0.05). On the third day after operation, CD3-CD16 CD56 in group P and group C were significantly decreased compared with those before operation (P0.05), while CD3-CD16 CD56 in group P was significantly lower than that in group C on the third day after operation (P0.05). The ratio of CD3 CD4 / CD3 CD8 in group C was significantly higher than that before operation on the 3rd day after operation (P0.05). The changes of cytokines in two groups: the level of IL-4 in IL-4:C group was significantly lower than that at T1 time point, and the IL-4 level at T6 time point in P group was significantly lower than that at each time point (P0.05). The expression of IL-4 in group C was significantly lower than that in group P at T5 time point (P0.05). The expression of IFN- 纬 at T6 time point in P group was significantly higher than that at T 2 T 3 and T 4 time points (P0.05), but there was no significant difference in other time points (P 0.05). There was no significant difference (P0.05) conclusion: the change of IL-4 was more obvious in low central venous pressure group. Low central venous pressure group had protective effect on immune function.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614;R735.7
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