The Effection Of Opioid Drugs On The Immune Function Of Gastrointestinal Cancer Patients In Laparoscopic Surgery

Objective：To explore the feasibility of general anesthesia without opioids ongastrointestinal cancer patients during laparoscopic surgery and compare its effectionon the recent immune function with traditional general anesthesia.Methods： Ninety gastrointestinal cancer patients, American Society ofAnesthesiologists physical status I-II,were scheduled to undergo electivelaparoscopic surgery, were completely randomly allocated to three groups,group A,30cases,traditional general anesthesia (with opioid drugs),group B,30cases, generalanesthesia combined with spinal anesthesia(with opioid drugs), group C,30cases,general anesthesia combined with spinal anesthesia(without opioid drugs). Entropyindex、mean arterial pressure、heart rate in the three groups were monitored andrecorded in the nine points in the times of Before induction of anesthesia(t1)、Beforetracheal intubation(t2)、 When tracheal intubation(t3)、1minute after trachealintubation(t4)、3minutes after tracheal intubation(t5)、Before incision(t6)、Whenincision(t7)、When intraoperative exploration(t8)、Drug withdraw(t9). Blood samples(2ml) were collected from the right internal jugular vein in the times of Beforeanesthesia induction (T1), At the end of surgery (T2),24h postoperative（T3）,72hpostoperative (T4),use flow cytometry method to detect CD3+, CD4+, CD8+,CD16/56+cell level, enzyme-linked immunoassay(ELISA) to detect theconcentration of IFN-γ、 IL-10. Statistical analyse the recovery time,extubationtime,24h postoperative VAS pain score,the time of ambulation after operation,postoperative anal exhaust time, discharge time of the three groups.Results：1、There were no statistical differences in entropy index, mean arterialpressure, heart rate of the nine points in the three groups (p>0.05).2、CD3+:in phase T3and T4, compared with group A and group B,the CD3+cells of group C were significantly increased,and the difference was statisticallysignificant (p <0.01),but the difference between group A and group B had no statistical difference (p>0.05);CD4+:in phase T2, T3, T4,compared with group A, the CD4+cells of group Band group C were significantly increased,and the difference was statisticallysignificant (p <0.05), compared with group B, group C increased moresignificantly,and the difference was statistically significant (p <0.05);CD8+：in phase T2, T3, T4, compared with group A, the CD8+cells of group Band group C were significantly decreased,and the difference was statisticallysignificant (p <0.05),but there were no statistical difference between group B andgroup C (p>0.05);CD4+/CD8+：in phase T2, T3, T4, compared with group A and group B,theCD4+/CD8+of group C increased significantly,and the difference was statisticallysignificant (p <0.01), but there were no statistical difference between group A andgroup B (p>0.05);CD16/56+: in phase T3, T4, compared with group A,the CD16/56+cells ofgroup B and group C were significantly increased,and the difference was statisticallysignificant (p <0.05), compared with group B, group C increased moresignificantly,and the difference was statistically significant (p <0.05);IFN-γ：in phase T4, compared with group A,the concentration of IFN-γ in groupB and group C was significantly increased,and the difference was statisticallysignificant (p <0.05),but there were no statistical difference between group B andgroup C (p>0.05);IL-10：in phase T2, compared with group B and group C,the concentration ofIL-10in group A was significantly increased,and the difference was statisticallysignificant (p <0.05),but there were no statistical difference between group B andgroup C (p>0.05);Recovery time: Compared with group A,the recovery time of group B and groupC was significantly decreased,and the difference was statistically significant (p <0.05), Compared with group B, group C decreased more significantly,and thedifference was statistically significant (p <0.05);Extubation time: Compared with group A and group B,the extubation time ofgroup C was significantly decreased,and the difference was statistically significant (p <0.05),but there were no statistical difference between group A and group B (p>0.05);24h postoperative VAS pain score: Compared with group A,the24hpostoperative VAS pain score of group B and group C were significantly decreased,and the difference was statistically significant (p <0.05), but there were no statisticaldifference between group B and group C (p>0.05);The time of ambulation after operation: the data of the three groups has nostatistical difference (p>0.05);Postoperative anal exhaust time: the data of the three groups has no statisticaldifference (p>0.05);Discharge time: the data of the three groups has no statistical difference (p>0.05);Conclusion： under the involved conditions, general anesthesia without opioidscombined with spinal anesthesia has better protective effect on the recent immunefunction of gastrointestinal cancer patients in laparoscopic surgery,and betterpostoperative recovery.