Effects Of Different Anaesthesia And Anagelsia On Perioperative Changes Of T-lymphocyte Subsets And Cytokines In Patients With Lung Cancer

Objective: The immune function of malignant neoplastic patient is dysfunction. Surgery and anaesthesia may cause it to reduce further. Most studies demonstrated that the anaesthetic and anaesthesia methods influence the immune function temporarily and reversible. But it is essential for us to adopt an anaesthesia method that maintain perioperative time and the immune function more steadily.Two more popular anaesthesia methods, total intravenous anesthesia and intravenous propofol-epidural anesthesia, were applied. Venous blood samples were collected at different perioperative time for determination of the expression of CD3+, CD4+,CD8+ on T-lymphocyte by flow cytometry(FCM) and calculation of proportion of CD4+ and CD8+, serum concentrations of IFN-γ, sIL-2R and IL-2 by ELISA, to evaluate the changes of immune function during the anaesthetic stage. In order to discover which method is better for the patients undergoing lobectomy of lung cancer.Methods: fourty-five ASAⅠorⅡpatients, without heart, liver or renal disfunction, aged 40~64yr and weigh index<30kg·m-2 udergoing radical operation for lung cancer were randomly allocated into three groups with 15 cases in each group respectively, EI, EE and TI. The patients were given midazolam 0.05mg·kg-1 and artropine 0.5mg·kg-1 intramuscularly 30 minutes before they enter the operating room. Take the blood pressure, heart reat and MAP as the baseline 5min after entering operating room, then establish the vein fluid road. TI was induced by propofol (target level 4μg/ml )and remifentanil (target level 6ng/ml), then were intubated endotraeheally and ventilated intermittently with Datex-Ohmeda anaesthesia machine. During operation propofol (target level 4~6μg/ml ) and remifentanil (target level 4~6ng/ml) were used to maintain. After operation, use patient controlled intravenous analgesia (PCIA). In EI and EE groups an epidural catheter was inserted at the interspace of T5~7 before induce. And 5ml 1.6% lidocaine was given, 5 minutes later began to induce, the method was the same with TI group. 0.375% ropivacaine (6~9ml) was given intermittently, and propofol was given to keep BIS at 45-60. In EE group patient controlled epidural analgesia (PCEA) was provided with 0.15% ropivacaine , tramadol (3mg/ml). In EI group PCIA was given.Perioperative monitoring included electrocardiogram (ECG) and heart rate (HR), non-traumatic mean arterial blood pressure (MAP), systolic blood pressure (SBP), diastolic arterial blood pressure (DBP), oxygen saturation of pulse blood (SpO2) and bispectral index (BIS). HR and BP not increased or decreased over 20% of the baseline. SpO2 was kept up 95%. BIS index was maintained at 45-60 by modifing propofol target concentration.5ml venous blood was drown from each patient at the following times: before induction of anesthesia(T0), 1h after the beginning of operation(T1), immediately after termination of operation(T2), 1d(T3) and 3d(T4) after the end of operation. T-lymphocyte subsets were determined by FCM, and cytokines by ELISA.Results:1 Compared group EI and group TI1.1 Changes of T-lymphocyte subsetsExcept CD8+, the other T-lymphocyte subsets began to decrese at T1 , group TI to the lowest at T2 , and rise at T3. At T4 the two groups still lower than preoperative. There had significant difference at T2 between two groups.1.2 Changes of cytokines1.2.1 Changes of the level of IL-2The serum concentrations of IL-2 decreased at T1 and T2, had significant difference at T2 between two groups.1.2.2 Changes of the level of sIL-2RThe level of sIL-2R was upgrade 1h after operation began, but has no significant difference. At T3, fallen down, and return to preoperative at T4. There has no significant difference between two groups.1.2.3 Changes of the level of IFN-γThe serum concentrations of INF-γdecreased at T1 and T2, had significant difference at T2 between two groups.2 Compared group EI and group EE2.1 Postoperative analgesiaThere was no significant difference in VAS gade between two groups, in EI group, two patients appeared dizzy.2.2 Changes of T-lymphocyte subsetsExcept CD8+, the other T-lymphocyte subsets of group EI decreased to the lowest at T3.Group EE return to preoperative at T4.There was significant difference between two groups at T4.2.3 Changes of cytokines2.3.1 Changes of the level of IL-2Group EI decreased to the lowest at T3, group EE began to return. There was significant difference between two groups .2.3.2 Changes of the level of sIL-2RThere was no significant difference between two groups.2.3.3 Changes of the level of IFN-γThere was no significant difference between two groups.Conclusion: Through the experiment we can discover that combined intravenous propofol and epidural anesthesia can not only keep the operation steady, but also affect the immune function little, is an ideal aneasthetic method for malignant neoplastic patient.