Effects Of Different Anesthesia And Analgesia On Celluer Immune Function And Stress Hormone In Patients Undergoing Lobectomy For Esophagus Cancer

Objective:The puprose of our investigation is to explore T lymphoeyte subsets, serum concentrations of cytokines and the mechanism of stress reaction in patients undergoing lobectomy for esophagus cancer, to evaluate the changes of immune function and stress reaction during the anaesthetic stage. In order to discover which method is better for the patients undergoing lobectomy for esophagus cancer.Methods:Sixty ASAâ… orâ…¡patients undergoing lobectomy for for esophagus cancer were randomly divided into two groups with 30 cases each.In group A, patients received general anesthesia and intravenous analgesia postoperatively;patients in group B received general anesthesia eombined with thoracic epidural anesthesia during surgery and received epidural analgesia postoperatively. The cervical venous blood samples were obtained at the following time points:30 min before induction of anesthesia(T0),2 h after skin incision (T1),4 h(T2),24 h(T3) and 48 h(T4)after the end of operation. The expression of T-lymphocyte subsets(CD4+,CD8+)was measured by flowcytometer, serum concentrations of sIL-2R and IL-2 by ELISA and stress hormone levels (GH,PRL,sIL-8 and Cor)were measured by RIA. The postoperative analgesic effects were measured by VAS.Results:(1)The changes of general state of two groups during operation:(2)Effects of analgesia:The effects of postoperative pain control in two groups were satisfactory.However the VAS scores in grou B was significantly lower than in grou A at T2 and T3(P<0.05).(3)Changes of T-lymphocyte subsets:The percentage of CD4+ and the CD4+/CD8+ ratios were similar before anesthesia among two groups. The percentage of CD4+ and the CD4+/CD8+ ratios in two groups decreased significantly from T1(P<0.05). The percentage of CD4+ and the CD4+/CD8+ ratios in B group was on the low-water mark at T2 and in A group was on the low-water mark at T3. The percentage of CD4+ in group B from T1 to T4 were significantly higher than those in group A(P<0.05). The CD4+/CD8+ ratios in group B from T3 to T4 were significantly higher than those in group A(P<0.05).(4) Changes of cytokines:The concentrations of IL-2 in two groups decreased significantly from T1(P<0.05). IL-2 in B group was on the low-water mark at T2 and in A group was on the low-water mark at T3. IL-2 in group B from T3 to T4 were significantly higher than those in group A(P<0.05).The concentrations of sIL-2R in two groups increased from T1 to T4,but there was no significantly different,compared with the values at T0.(5)Changes of the mechanism of stress reactionThe levels of GH concentrations of group A step up gradually atfer anesthesia and beginning of operation and aehieved their Peak at T1 time point, then full-off after T2.There was no difference statistieally of GH concentrations in seurm at every time point in group B(P>0.05). The levels of GH concentrations of group A was higher than that of group B at T1 to T4.The levels of PRL concentrations of two groups step up gradually atfer anesthesia and beginning of operation and achieved their Peak at T1 time point,then full-off after T2.The levels of PRL concentrations of group A at T4 was higher than that before anesthesia, the levels of PRL concentrations of group B came back the level before anesthesia.The levels of PRL concentrations of group A was higher than that of group Bat T1 to T4.The levels of IL-8 concentrations of two groups decreased at T1 to T4. There was no difference statistieally of IL-8 concentrations in seurm at every time point in group A(P>0.05). The levels of IL-8 concentrations of group B at T1 to T4 was lower than that before anesthesia(P<0.05). The levels of IL-8 concentrations of group B decreased statistieally,compared with group A at T1 to T4.There were no difference statistically of Cor concentrations of two groups at TO to T1 (P>0.05).But The levels of Cor concentrations of two groups step up statistically at T2 time point,then full at T3 and decreaded at T4. The levels of Cor concentrations of group B increased statistieally, compared with group A at T2 to T3.Conclusion:1.The immune function of patients with esophageal cancer after thoracic surgery has been further inhibited. General anesthesia combined with thoracic epidural anesthesia and PCEA may reduce the effect on celluer immune function.2.Various anesthetic methods have different effects on the level of stress reaction in the patients undergoing lobectomy for esophagus cancer. General anesthesia combined with thoracic epidural anesthesia and PCEA may reduce the stress reaction.3. General anesthesia combined with thoracic epidural anesthesia and PCEA is an ideal aneasthetic method for patient with esophagus cancer.