| Aim:To investigate the impact of enhanced recovery after surgery(ERAS)pathway on peripheral the levels of Th1/Th2 cytokines in patients undergoing laparoscopic radical cervical cancer surgery.Method:1、60 patients of both sexes,aged 45-65 yr,with body mass index of 18-25kg/m~2,of American Society of Anesthesiologisits physical status I or III,scheduled for elective laparoscopic radical cervical cancer surgery,were randomly divided into 2groups(n=30 each)according to the random number table,enhanced recovery after surgery group(group E):the patients were received enhanced recovery after surgery pathway;conventional surgery group(group C):the patients were received routine perioperative management and anesthesia methods.Both groups of surgeries were performed by the same group of surgeons.2、The surgical procedures,the duration of operation and anesthesia,the amount of bleeding,urine volume,the volume of fluid input,the intraoperative sufentanil consumption,the preoperative and postoperative CVP and temperature were recorded in two groups.Before induction(T0),at the end of operation(T1),on 1 day(T2),3 day(T3),7 day(T4)after operation,3ml venous blood samples were collected for determination of serum concentrations Th1 cytokines such as IFN-γ、IL-2 and Th2cytokines such as IL-4、IL-6(by enzyme-linked immunosorbent assay),Th1/Th2 cell equilibrium was evaluated by the level of IFN-γ/IL-4、IFN-γ/IL-6,Th1/Th2 ratio was calculated.Furthermore,the visual analogue scale(VAS)score and Ramsay score were evaluated on 4 hours after operation,8 hours after operation,24 hours after operation and 48 hours after operation in two groups.Result:1、Compared with group C,the intraoperative sufentanil consumption,the volume of fluid input,the postoperative CVP,the visual analogue scale(VAS)score on 4 hours after operation,8 hours after operation,24 hours after operation were significantly decreased(P<0.05)in group E were significantly decreased,while the postoperative temperature was significantly increased(P<0.05).2、Compared with T0,the serum IL-6 concentration in group C on T2-4 and group E on T2-3 were significantly increased,the serum IFN-γand IL-2 concentrations in group C on T2-4 and group E on T2-3 were significantly decreased(P<0.05),the serum IL-4 concentration was increased(P>0.05),the Th1/Th2 ratio were significantly decreased(P<0.05).3、Compared with group C,the serum IFN-γand IL-2 concentrations in group E on T2-4 were significantly increased,the serum IL-6 concentration in group E on T2-4were significantly decreased(P<0.05),the serum IL-4 concentration was decreased(P>0.05);the Th1/Th2(IFN-γ/IL-4)ratio in group E on T2-4 was respectively[(3.67±1.26)、(4.11±1.44)、(4.82±1.71)],which was significantly increased compared with that in the group C(P=0.012、0.029、0.015);the Th1/Th2(IFN-γ/IL-6)ratio in group E on T2-4 was respectively[(2.71±1.02)、(3.25±1.26)、(4.67±1.85)],which was significantly increased compared with that in the group C(P<0.001).Conclusion:ERAS pathway applicated to patients undergoing laparoscopic radical cervical cancer surgery can significantly reduce the perioperative period sufentanil total consumption and prevent the occurrence rate of hypothermia,it can increase the ratio of Th1/Th2 and alleviate cellular immunosuppression after the surgery,provide satisfactory postoperative analgesic,which is beneficial to the enhanced recovery. |
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