背景:麻醉诱导的免疫抑制在肿瘤手术中特别令人感兴趣。本研究旨在探讨4种常用全身麻醉技术对口腔癌皮瓣重建患者免疫功能的影响。
方法:116例患者随机分为4组。S组患者给予七氟醚为主的麻醉。P组给予丙泊酚为主的麻醉。SD组采用七氟醚复合右美托咪定麻醉。丙泊酚复合右美托咪定麻醉(PD)组接收PD。在5个时间点获得血样:基线(T0),操作开始后1小时(T1),操作结束(T2),24小时(T3),术后48小时(T4)。淋巴细胞亚群(包括CD3+,CD4+,CD8+,和B淋巴细胞)和树突状细胞通过流式细胞术分析。血糖,去甲肾上腺素,和皮质醇水平分别使用ELISA和血气分析仪进行测量。
结果:总计,107名患者纳入最终分析。免疫学指标,除了CD8+计数,S组全部下降,P,T1-4时的SD与基线值相比,和CD3+的计数,CD4+,和树突状细胞,以及CD4+/CD8+比率,PD组明显高于S组,P,和SD在T1-3(P<0.05)。在任何观察时间点,P和SD组之间均无显着差异。术中应力指数,包括去甲肾上腺素和皮质醇水平,PD组在T1-2时显著低于其他3组(P<0.05)。
结论:这些发现表明,PD作为一种可能的最佳选择可以减轻口腔癌皮瓣重建患者的免疫抑制。
BACKGROUND: Anesthetic-induced immunosuppression is of particular interest in tumor surgery. This study aimed to investigate the influence of the 4 most common general anesthetic techniques on immune function in patients undergoing flap reconstruction for oral cancer.
METHODS: 116 patients were randomly divided into 4 groups. Patients in group S were given sevoflurane-based anesthesia. Group P was administered propofol-based anesthesia. The SD group received sevoflurane combined with
dexmedetomidine anesthesia. The propofol combined with
dexmedetomidine anesthesia (PD) group received PD. Blood samples were obtained at 5 time points: baseline (T0), 1 hour after the start of the operation (T1), end of the operation (T2), 24 hours (T3), and 48 hours (T4) after the operation. Lymphocyte subsets (including CD3+, CD4+, CD8+, and B lymphocytes) and dendritic cells were analyzed by flow cytometry. Blood glucose, norepinephrine, and cortisol levels were measured using ELISA and a blood gas analyzer respectively.
RESULTS: In total, 107 patients were included in the final analysis. Immunological indicators, except CD8+ counts, were all decreased in groups S, P, and SD at T1-4 compared with the baseline value, and the counts of CD3+, CD4+, and dendritic cells, as well as CD4+/CD8+ ratios, were significantly higher in the PD group than in the S, P, and SD at T1-3 (P < .05). There were no significant differences between groups P and SD at any observation time point. Intraoperative stress indices, including norepinephrine and cortisol levels, were significantly lower in the PD group than in the other 3 groups at T1-2 (P < .05).
CONCLUSIONS: These findings suggest that PD as a probably optimal choice can alleviate immunosuppression in patients undergoing flap reconstruction for oral cancer.