摘要
目的 比较三种麻醉方法对肾移植病人术中免疫功能的影响。方法 39例尿毒症且无其他免疫系统疾患的病人随机分为三组,Ⅰ组为连续硬膜外麻醉组(n=13),Ⅱ组为蛛网膜下腔.硬膜外联合麻醉组(n=13),Ⅲ组为静吸复合全身麻醉组(n=13),所有病人均于麻醉后开始输血,根据病人入室血压决定输血量,范围为600-800 ml。三组病人于麻醉前、麻醉后、输血前、输血后30min、输血后1 h、开放动静脉、术毕、术后1 d和3 d检测外周静脉血CD+3、CD+4、CD+8、CD+4,CD+8和IgG、IgA、IgM、C3、C4值。结果 三组病人平均输血量为700 ml,差异无显著性。三组组间免疫球蛋白及补体比较各时点对应检测值差异无显著性(P>0.05);三组组内免疫球蛋白(IgG、IgA、IgM)及补体(C3、C4值)麻醉后各时间点与麻醉前相比,差异无显著性(P>0.05)。Ⅰ组和Ⅱ组,麻醉后CD+3、CD+4、CD+4/CD+8与麻醉前相比,差异无显著性(P>0.05);而输血后CD+3、CD+4、CD+4/CD+8值下降明显,与麻醉前、输血前相比,差异有显著性(P<0.05-0.01),术后1 d回升、3 d处于高水平;CD+8各时间点与麻醉前相比,无统计学意义(JP>0.05)。Ⅲ组CD+3、CD+4、CD+4/CD+8值麻醉后开始下降,与麻醉前、输血前比较,差异有显著性(P<0.05),输异体血后下降更明显,差异非常显著(P<0.01),术后第一天仍未恢复?
Objective To compare the effects of different methods of anesthesia on immune function during renal transplantation. Methods Thirty-nine uremic patients of both sexes (20 male, 19 female) aged 19-65 yr, undergoing renal transplantation were studied. Patients who had infection, fever, immune system disease or had received immunoregulatory drugs were excluded. The patients were randomly divided into 3 equal groups: Ⅰ continuous epidural anesthesia group (CEA , n = 13); Ⅱ combined spinal-epidural anesthesia group (CSEA, n = 13) and Ⅲ general anesthesia group (GA , n = 13). In group I an epidural catheter was inserted at T12-L1 or L1-2 into epidural space and advanced in cephalad direction and a mixture of 2% lidocaine and 0.7% dicaine (1: 1) 11-12 ml was given. The height of block was T8 In group II CSEA was performed at L2-3 and a mixture of 1% dicaine, 10% glucose and 3% ephedrine (1 : 1 : 1) 3 ml was injected intrathecally. An epidural catheter was threaded in a cephalad direction. The block height was T8. 2 % lidocaine was given epidurally when the operation lasted more than 2 hours. In both group I and II pathidine 50 mg and droperidol 5 mg were given iv. In group III anesthesia was induced with fentanyl 5 μg kg-1 , etomidate 0.3 mg · kg-1 and vecuronium 0.08 mg · kg-1 and maintained with isoflurane supplemented with intermittent iv boluses of vecuronium. Blood samples were obtained from peripheral vein for determination of CD+3 , CD+4 , CD+8 , CD+4 /CD+8 ratio and IgG, IgA, IgM, C3 , C4 before anesthesia (T0 ) , after anesthesia (T1), before blood transfusion (T2), 30 min and 1 h after blood transfusion (T3,4) ,when renal circulation was restored (T5), at the end of operation (T6 ) and 1 and 3 days after operation (T7.8) .Results There were no significant changes in T lymphocyte subgroups, immunoglobulins and complements measured after anesthesia (T1 ) as compared with the baseline values(T0) in the 3 groups. In group Ⅰ and Ⅱ CD+3 , CD+4 , IgG, IgA, IgM, C3 , C4 and CD+8 unchanged significantly as compared with the baseline values (T0 ) ; CD+4 /CD+8 ratio decreased after anesthesia ( P < 0.01 ) and continued decreasing after homologous blood transfusion and started increasing on the 1st postoperative day and kept on increasing on the 3rd postoperative day. In group Ⅲ CD+3 , CD+4 decreased significantly (P < 0.05) and kept on decreasing after homologous blood transfusion (P < 0.01); CD+8 unchanged significantly compared with the baseline. Conclusion Continuous epidural anesthesia and combined spinal-epidural anesthesia have less effects on patients T-lymphocyte and humoral immune function during renal transplantation, while general anesthesia can inhibit patient's immune function. In addition homologous blood transfusion has more profound effects on immune function.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2003年第8期583-586,共4页
Chinese Journal of Anesthesiology
