The effects of continuous epidural anesthesia and analgesia on stress response and immune function in patients undergoing radical esophagectomy
The effects of continuous epidural anesthesia and analgesia on stress response and immune function in patients undergoing radical esophagectomy
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DOI：
10.1213/01.ane.0000184287.15086.1e
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发表时间：
2005-11-01
影响因子：
5.7
通讯作者：
Morita, K
中科院分区：
文献类型：
--
作者：
Yokoyama, M;Itano, Y;Morita, K
我们研究了根治性食管切除术患者围手术期广泛硬膜外阻滞（C3-L）是否影响术后免疫反应。接受根治性食管切除术的患者随机分为两组，一组为全麻，通过2个硬膜外导管持续硬膜外输注，并继续用于术后镇痛（E组，n = 15），另一组为术中全麻和术后IV吗啡镇痛（G组，n = 15）。在手术前和手术后以及术后第1天和第3天评估血浆应激激素、细胞因子、C反应蛋白（CRP）、白细胞计数和淋巴细胞亚群分布。与E组相比，手术结束时血浆肾上腺素水平显著升高（P < 0.05）和手术结束时去甲肾上腺素水平（P < 0.01）和POD 1（P < 0.01）和POD 3 G组术后CD 4/CD 8比值明显降低（P < 0.05）。然而，组间其他变量无显著差异。两组患者术后血浆皮质醇、促肾上腺皮质激素、白细胞介素（IL）-1 β、IL-6、IL-10和CRP水平均升高（每组P < 0.01），且术后第1天和第3天IL-1 β、IL-6、IL-10和CRP水平仍升高（每种变化，每组P < 0.01）。白细胞计数在PODI（各组P < 0.05）和POD 3（各组P < 0.01）时均升高。术后至术后第3天淋巴细胞比例下降（各组P < 0.01）。B细胞比例在POD 1时增加（各组P < 0.01），NK细胞比例在POD 1和POD 3时减少（各组P < 0.01）。我们的结论是，组织损伤和炎症明显克服了广泛硬膜外阻滞对应激反应和免疫功能的影响，在食管癌根治术。
We investigated whether perioperative extensive epidural block (C3-L) affects postoperative immune response in patients undergoing radical esophagectomy. Patients undergoing radical esophagectomy were randomly assigned to either general anesthesia with continuous epidural infusion via 2 epidural catheters that was continued for postoperative analgesia (group E, n = 15) or intraoperative general anesthesia and postoperative IV morphine analgesia (group G, n = 15). Plasma levels of stress hormones, cytokines, C-reactive protein (CRP), leukocyte counts, and distribution of lymphocyte subsets were assessed before and after surgery and on postoperative days (PODs) 1 and 3. In comparison with group E, significant increases in plasma epinephrine level at the end of surgery (P < 0.05) and norepinephrine level at the end of surgery (P < 0.01) and on POD1 (P < 0.01) and POD3 (P < 0.01) and significant decrease in cluster of differentiation (CD4/CD8 ratio) at the end of surgery (P < 0.05) were observed in group G. However, there were no significant differences in other variables between groups. In both groups, plasma cortisol, adrenocorticotropic hormone, interleukin (IL)-1 beta, IL-6, IL-10, and CRP levels were increased after surgery (each group P < 0.01) and IL-1 beta, IL-6, IL-10, and CRP were still increased on POD1 and POD3 (each change, each group P < 0.01). Leukocyte counts were increased on PODI (each group P < 0.05) and POD3 (each group P < 0.01). The proportion of lymphocytes decreased from the end of surgery to POD3 (each group P < 0.01). The proportion of B cells was increased on POD1 (each group P < 0.01); that of natural killer cells was decreased at PODI and POD3 (each group P < 0.01). We conclude that tissue damage and inflammation apparently overcome the effects of extensive epidural block on stress response and immune function in radical esophagectomy.