Effects Of Different Anesthetic And Analgesic Techniques On Expression Of Immunocyte Surface Antigen And Receptor In Patients Undergoing Thoracic Surgery

Objective:to investigate the effects of different anesthetic and analgesic techniques on the T-lymphocyte subsets(CDS,CD4,CDS),monocyte CD14 and lymphocyte CD25 expression in the patients undergoing thoracic surgery.Methods:Thirty patients,ASA physical status lor II,undergoing elective thoracic surgery,were randomly allocated to one of the three groups with 10 cases each:group I ,general anesthesia(GA) and postoperative patient-controlled intravenous analgesia(PCIA) with morphine;group II,general anesthesia(GA) and postoperative patient-controlled intravenous analgesia(PCIA) with tramadol;group III,general anesthesia(GA) plus thoracic epidural anesthesia(TEA) and postoperative patient-controlled intravenous analgesia(PCIA) with tramadol. The peripheral venous blood samples were obtained at the following time points:at baseline before induction of anesthesia (Tl),immediately after completion of surgery(T2),4h after completion of surgery(T3) and on postoperative days 1 (T4) and 3(T5). The expression ofT-lymphocyte subsets,monocyte CD14,and lymphocyte CD25 were measured by using monoclonal antibody staining and flow cytometer,and plasma cortisol levels were measured by RIA. The postoperative analgesic effects were evaluated by VAS.Results:(1) The postoperative analgesic effects were similar in all three groups;in fact,the VAS values were not significantly different at rests,but in group III,when the patients acted such as cough or deep breath,the VAS values at T3 and T4 were lower than in group I and II. (2) Compared with the basal values,the plasma glucose and cortisol levels were significantly increased at T2,T3 and T4 in group I and II (P<0. OS),while in group III,the levels were not increased so largely than in group I andII ;In all the three groups,the plasma glucose and cortisol levels returned to baseline at T5. (3) The levels of CDS,CD4,CD4/CD8,CD25 and CD14 were significantly decreased at T2 and T3 than at Tl in group I and II (P<0. 05),in group I ,the levels of CD3,CD4,CD4/CD8,CD25 and CD14 were remained lowly at T4,but in group II,the levels were largely enhanced at T4 than at T2;in group III,the levels of CD3,CD4,CD4/CD8,CD25 and CD14 were less decreased than in group land II.Conclusions:(1) The thoracic surgery under general anesthesia combined thoracic epidural anesthesia induced less surgical stress response and postoperative immunosuppression than general anesthesia alone. (2) The analgesic tramadol has less immunosuppression effects than morphine.