Effects of epidural anaesthesia on surgical stress-induced immunosuppression during upper abdominal surgery
Effects of epidural anaesthesia on surgical stress-induced immunosuppression during upper abdominal surgery
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DOI：
10.1093/bja/ael334
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发表时间：
2007-02-01
影响因子：
9.8
通讯作者：
Sata, T.
中科院分区：
文献类型：
--
作者：
Kawasaki, T.;Ogata, M.;Sata, T.
背景以前，我们已经证明，手术应激迅速诱导短暂的低反应性血细胞内毒素和单核细胞mCD 14和HLA-DR的表达下降后不久，手术开始全身麻醉。本研究旨在探讨硬膜外麻醉对上腹部手术患者手术应激诱导的免疫抑制的影响。在获得知情同意后，患者被随机分配接受全身麻醉（G组）或全身麻醉加硬膜外麻醉（E组）。检测围术期中性粒细胞吞噬功能、中性粒细胞呼吸爆发功能、单核细胞mCD 14和HLA-DR表达、血浆IL-10浓度和LPS诱导的全血TNF-α产生。在G组和E组中，手术应激均迅速降低了中性粒细胞吞噬活性、单核细胞mCD 14和HLA-DR表达以及LPS诱导的TNF-α产生（P < 0.05 vs术前）。两组患者术后2 h血浆IL-10浓度均显著升高（P < 0.05）。两组之间无显著差异。两组中性粒细胞呼吸爆发活动在手术过程中均无变化。这项研究表明，先天免疫系统从上腹部手术的早期就受到抑制。亚组分析表明，硬膜外麻醉T4皮刀以及全身麻醉可能无法保护患者免受这种免疫抑制。这些结果部分解释了在围手术期看到的宿主防御机制的损害。
Background. Previously, we have demonstrated that surgical stress rapidly induced transient hyporesponsiveness of blood cells to endotoxin and that monocyte mCD14 and HLA-DR expression decreased soon after the start of surgery under general anaesthesia. This study was designed to investigate the effects of epidural anaesthesia on surgical stress-induced immunosuppression in patients undergoing upper abdominal surgery.Methods. After having obtained informed consent, patients were randomly allocated to receive general anaesthesia (Group G) or general anaesthesia with epidural anaesthesia (Group E). Perioperative changes in neutrophil phagocytic activity, neutrophil respiratory burst activity, monocyte mCD14 and HLA-DR expression, plasma IL-10 concentration, and the LPS-induced TNF-alpha production in whole blood were measured.Results. Surgical stress rapidly depressed neutrophil phagocytic activity, monocyte mCD 14 and HLA-DR expression, and LPS-induced TNF-alpha production ex vivo (P < 0.05 vs preoperation) in both Group G and Group E. In contrast, the plasma IL-10 concentration increased significantly 2 h after the start of surgery (P < 0.05) in both groups. There were no significant differences between the two groups. The neutrophil respiratory burst activity did not change during the operation in either group.Conclusion. This study showed that the innate immune system is suppressed from the early period of upper abdominal surgery. Subgroup analysis suggested that epidural anaesthesia to T4 dermatome as well as general anaesthesia may not protect patients from this immunosuppression. These results in part explain the impairment of host-defense mechanisms seen in the perioperative period.