七氟醚对行胃癌根治术的老年患者外周血淋巴细胞亚群的影响

发布时间：2018-05-13 03:42

本文选题：七氟醚 + 胃癌　；参考：《大连医科大学》2017年硕士论文

【摘要】：背景:当今社会肿瘤的发病率日渐升高,手术是治疗肿瘤患者的主要手段之一,患者良好的免疫功能会在很大程度上提高自身的存活率,人体外周血淋巴细胞的数目可反映人体免疫功能的高低,而围术期的手术刺激、麻醉药物以及麻醉方式都会影响患者的免疫功能。为了探究七氟醚麻醉对行腹腔镜胃癌根治术的老年患者围术期免疫功能的影响,我们观察了七氟醚麻醉下行腹腔镜胃癌根治的老年患者围术期外周血淋巴细胞亚群数量的变化,从而探究七氟醚麻醉对老年胃癌患者围术期免疫功能变化的影响。方法:通过我院伦理委员会批准,选择19例2016年11月至2017年02月来自胃肠外科年龄在60~80岁之间的胃癌患者,ASA分级Ⅰ~Ⅱ级,采用统一的给药标准进行麻醉诱导与维持,手术均为当日首台(8:00 AM),并由同一组外科大夫进行。分别抽取患者麻醉诱导开始前10min(T1),麻醉诱导后5min(T2),手术开始即刻(T3),手术开始后30min(T4),手术结束所有维持药物停药即刻(T5),术后24小时(T6)以上六个时间点的外周血,采用流式细胞仪技术测定外周血中T淋巴细胞(CD3+)绝对值、B淋巴细胞(CD19+)绝对值、NK细胞(CD3-CD16+和/或CD56+)绝对值的变化,并且观察记录每一个时间点患者的血压、心率、脉氧饱和度、BIS。结果:(1)患者生命体征变化:与麻醉诱导前10min(T1)相比,麻醉诱导后5min(T2)、手术开始即刻(T3),患者的血压、心率、BIS均下降,P0.05,结果具有统计学意义。且T3与T2相比,T3时刻患者血压、心率继续下降,具有统计学意义。随着麻醉与手术的进行,手术结束所有维持药物停药即刻(T5)、手术后24小时(T6)患者心率、血压恢复至术前水平,与术前相比无统计学意义。患者脑电双频指数(BIS)在麻醉诱导后5min(T2)开始下降,与T1时刻相比有统计学意义。在整个手术过程中,患者BIS值维持在较恒定的状态,T2、T3、T4时刻BIS值相互之间比较无统计学差异。在手术结束所有维持药物停药即刻(T5),患者的BIS值较T4时刻上升,有统计学意义。(2)患者外周血淋巴细胞亚群数量变化:与麻醉诱导前10min(T1)相比,患者诱导后5min(T2)、手术开始即刻(T3)用流式细胞仪测定的外周血T淋巴细胞(CD3+)绝对值、B淋巴细胞(CD19+)绝对值、NK细胞(CD3-CD16+和/或CD56+)绝对值均下降,P0.05,结果具有统计意义;T3与T2相比三种细胞绝对值下降,结果具有统计学意义。手术开始后30min(T4)与手术开始即刻(T3)相比三种细胞数量上升,有统计学意义,随着手术的持续进行,手术结束所有维持药物停药即刻(T5)与T4相比,外周血中三种免疫细胞数量明显下降,P0.05,结果具有统计学意义;手术结束所有维持药物停药即刻(T5)与麻醉诱导前10min(T1)相比,外周血T淋巴细胞(CD3+)绝对值、B淋巴细胞(CD19+)绝对值均未能恢复至术前水平,P0.05,结果具有统计学意义;术后24h(T6)与术前(T1)相比,外周血T淋巴细胞(CD3+)绝对值、B淋巴细胞(CD19+)绝对值、NK细胞(CD3-CD16+和/或CD56+)绝对值均未能恢复至术前水平,P0.05,结果具有统计学意义。结论:七氟醚吸入麻醉会使老年胃癌患者外周血淋巴细胞数量下降,该抑制作用在麻醉诱导后即产生,且随着吸入七氟醚时间延长及吸入量的增加而逐渐显著;手术刺激会使老年胃癌患者外周血淋巴细胞亚群数量一过性上升,但随着手术的进行及麻醉时间的延长,外周血淋巴细胞各亚群数量均显著下降,且在手术结束及术后24小时未能恢复至术前水平。
[Abstract]:Background: the incidence of tumor in the society is increasing day by day. Surgery is one of the main methods for the treatment of cancer patients. The good immune function of the patient will improve the survival rate to a great extent. The number of lymphocytes in the peripheral blood of the human body can reflect the body's immune function, and the perioperative stimulation, narcotic drugs and anaesthesia In order to explore the effects of sevoflurane anesthesia on the perioperative immune function of the elderly patients undergoing laparoscopic radical gastrectomy, we observed the changes in the number of peripheral blood lymphocyte subsets in the peri operative period of the elderly patients undergoing laparoscopic radical gastrectomy under sevoflurane anesthesia, thus exploring the sevoflurane anesthesia. The influence of the perioperative immune function changes in the elderly patients with gastric cancer. Methods: through the approval of our hospital ethics committee, 19 cases of gastric cancer from November 2016 to 02 months were selected from the gastrointestinal surgery age of 60~80 years old, ASA grade I ~ II grade, the uniform administration standard was used to induce and maintain the intoxication, the operation was the first stage of the day (8:00 AM). And by the same group of surgeons, 10min (T1) before induction of anesthesia induction, 5min (T2) after anesthesia induction, operation start immediately (T3), 30min (T4) after the operation, all maintenance drug withdrawal immediately (T5), and six time points above 24 hours (T6) after operation, and flow cytometry to determine peripheral blood. The absolute value of T lymphocyte (CD3+), the absolute value of B lymphocyte (CD19+), the absolute value of NK cells (CD3-CD16+ and / or CD56+), and observe the blood pressure, heart rate, pulse oxygen saturation and BIS. results at each time point: (1) the changes of vital signs: Compared with 10min (T1) before induction of anesthesia, 5min (T2) after induction of anesthesia, operation begins immediately T3, the patient's blood pressure, heart rate, BIS decreased, P0.05, and the results were statistically significant. And T3 and T2, the blood pressure, heart rate continued to decline, with statistical significance. With the anesthesia and operation, all the maintenance drugs were stopped immediately after the operation (T5), the heart rate of the 24 hours (T6) after the operation, the blood pressure was restored to the preoperative level, There was no statistical significance compared with preoperative. The bispectral index (BIS) of the patients began to decrease after the induction of 5min (T2) after anesthesia induction, and was statistically significant compared with the time of T1. During the whole operation, the patient's BIS value remained at a relatively constant state, and there was no statistical difference between T2, T3, and T4 at the time of the operation. All drug withdrawal at the end of the operation Immediately (T5), the BIS value of the patient was higher than that of T4. (2) the number of lymphocyte subsets in the peripheral blood of the patients: compared with 10min (T1) before induction of anesthesia, the patients were induced to 5min (T2), and the absolute value of T lymphocyte (CD3+), B lymphocyte (CD19+), was measured by flow cytometry. The absolute value of -CD16+ and / or CD56+) decreased, P0.05, and the results were statistically significant. Compared with T2, the absolute values of the three cells decreased and the results were statistically significant. After the operation, the number of three cells increased in 30min (T4) compared with the operation beginning immediately (T3), with statistical meaning, with the operation continuing, all the maintenance drugs were stopped at the end of the operation. Compared with T4, the number of three immune cells in peripheral blood decreased significantly in peripheral blood, P0.05, and P0.05, and the results were statistically significant. The absolute value of T lymphocyte (CD3+) in peripheral blood (CD3+) and B lymphocyte (CD19+) were not recovered to the preoperative level, P0.05, the result of all the maintenance drug withdrawal (T5) and 10min (T1) before the anesthesia induction. The absolute value of T lymphocyte (CD3+) in peripheral blood, B lymphocyte (CD19+) absolute value, NK cell (CD3-CD16+ and / or CD56+) absolute values were not recovered to preoperative level, P0.05, and the results were statistically significant. Conclusion: sevoflurane inhalation anesthesia will make peripheral blood lymphatic in elderly patients with gastric cancer. Conclusion: 24h (CD3+) absolute value of peripheral blood (CD3+), B lymphocyte (CD19+) absolute value, NK cells (CD3-CD16+ and / or CD56+) can not be recovered to the preoperative level, P0.05, and the results are statistically significant. The number of cells decreased, the inhibitory effect was produced after anesthesia induction, and gradually increased with the prolonged inhalation of sevoflurane and the increase of inhalation. The surgical stimulation would increase the number of lymphocyte subsets in the peripheral blood of the elderly patients with gastric cancer, but the number of lymphocyte subgroups in the peripheral blood with the operation and anesthesia time prolonged. The volume decreased significantly and failed to recover to the preoperative level at the end of operation and 24 hours after operation.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614;R735.2

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