Effects Of Esketamine And Opioids On Cellular Immunity,IL-6and IL-10 In Patients Undergoing Laparoscopic General Anesthesia

Objective:To compare the effects of ketamine and opioids on cellular immunity,IL-6 and IL-10 in patients undergoing laparoscopic general anesthesiaMethods:A total of 50 patients who underwent laparoscopic non-oncologic gynecological surgery under general anesthesia in the Second Hospital of Shanxi Medical University from September 2020 to February 2021 were selected and divided into ketamine group（group K）and opioid group（group O）according to random number table method,with25 patients in each group.At the beginning of anesthesia induction,ketamine 0.5mg/kg was injected intravenously in group K and sufentanil 0.2～0.4ug/kg in group O.Anesthesia maintenance.The initial administration rate of ketamine in group K was0.5mg·kg^-1·h^-1,and the pumping speed was adjusted according to the actual situation.In group O,remifentanil was 10～20ug·kg^-1·h^-1;Anesthesia was terminated.Ketamine and propofol were discontinued 30min and 5min before the end of surgery in group K.In group O,propofol and remifentanil were discontinued 5 minutes before the end of operation.All filter into the groups of patients before anesthesia induction（T₁）,never put off till tomorrow what you can awake after extubation（T₂）peripheral venous blood collected 2 ml,using flow cytometry to detect T lymphocyte subsets(CD3⁺,CD4⁺,CD8⁺,CD4⁺CD25⁺CD127^lowcells,NK cells（CD3^-CD16⁺CD56⁺）percentage,B lymphocyte percentage,and calculate the CD4⁺/CD8⁺ratio,adopt multiple microspheres fluorescence detection of cytokines IL-6,IL-10.Blood routine was collected before operation and the second day after operation,and neutrophil lymphocyte ratio（NLR）and platelet lymphocyte ratio（PLR）were calculated.Results:Compared with T₁,the percentages of CD3⁺and CD4⁺cells and the ratio of CD4⁺/CD8⁺in K and O groups were decreased at T₂,while the levels of IL-6 and IL-10were increased（P<0.05）;WBC,neutrophil（N）,monocyte（M）count increased,lymphocyte count（L）decreased,NLR value increased significantly（P<0.05）.Compared with group O,the percentage of CD3⁺,CD4⁺cells,CD4⁺/CD8⁺ratio,the percentage of NK cells and the level of IL-10 were higher and the level of IL-6 was lower in Group K at T₂（P<0.05）;WBC,M,N and L cell counts were higher（P<0.05）.Conclusion:Compared with opioid anesthesia,ketamine anesthesia has less inhibition of cellular immunity in patients undergoing laparoscopic surgery,and can reduce the postoperative IL-6 response and increase the release of IL-10.