低中心靜脈壓對肝癌手術(shù)患者圍術(shù)期免疫功能的影響
發(fā)布時(shí)間：2018-11-02 08:17
【摘要】：目的:探討低中心靜脈壓(Low central venous pressure,LCVP)對肝癌手術(shù)患者圍術(shù)期免疫功能的影響。方法:采用前瞻性研究方法,選擇2016年10月至2017年1月我院收治的術(shù)前確診為肝細(xì)胞肝癌并擇期行肝葉部分切除術(shù)的患者40例。按照隨機(jī)數(shù)字法分為對照組(P組:傳統(tǒng)液體管理方法,CVP維持在6-12cmH2O)和控制性降CVP組(C組:限制液體輸入速度,肝門阻斷期間將CVP維持在3-5cmH2O),每組20例。兩組均采取相同的麻醉和手術(shù)方案,于誘導(dǎo)前3min(T1)、誘導(dǎo)后3min(T2)、肝門阻斷前3min或控制性降CVP前3min(T3)、肝葉切除后3min(T4)、手術(shù)結(jié)束時(shí)(T5)和術(shù)后24h(T6)六個(gè)時(shí)間點(diǎn)記錄患者血流動(dòng)力學(xué)情況,手術(shù)結(jié)束時(shí)記錄患者的輸液量、出血量、尿量及輸血量,并抽取中心靜脈血2.0 m L離心取血清低溫存放,采用酶聯(lián)免疫吸附試驗(yàn)檢測患者六個(gè)時(shí)間點(diǎn)血清白介素(IL)-4、干擾素(IFN)-γ和轉(zhuǎn)錄生長因子(TGF)-β1的濃度。常規(guī)檢測患者術(shù)前、術(shù)后第三天的肝轉(zhuǎn)氨酶ALT、AST水平及免疫功能指標(biāo)。結(jié)果:兩組血流動(dòng)力學(xué)變化:于T4時(shí)間點(diǎn),C組心率高于P組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);C組平均動(dòng)脈壓低于P組,差異有統(tǒng)計(jì)學(xué)意義(P0.05),但均在正常數(shù)值范圍內(nèi)波動(dòng),術(shù)中其他時(shí)間點(diǎn)比較差異無統(tǒng)計(jì)學(xué)意義(均P0.05)。兩組液體管理比較:C組輸液總量、失血總量、輸血總量和尿量均比P組減少,差異有統(tǒng)計(jì)學(xué)意義(均P0.05)。兩組ALT和AST的變化:兩組患者術(shù)前和術(shù)后第三天ALT和AST數(shù)值比較,差異無統(tǒng)計(jì)學(xué)意義(均P0.05);但兩組患者術(shù)后第3 d的ALT和AST均明顯較術(shù)前基礎(chǔ)值升高(均P0.05)。兩組免疫功能變化:C、P兩組體液免疫IgG、IgM和IgA術(shù)后3天與術(shù)前比較均明顯降低,差異有統(tǒng)計(jì)學(xué)意義(均P0.05),C、P兩組間IgG、IgM、IgA水平比較,差異無統(tǒng)計(jì)學(xué)意義(均P0.05)。兩組術(shù)后第3天與術(shù)前CD3+、CD3+CD4+、CD3+CD8+、CD19+數(shù)值比較,差異均無統(tǒng)計(jì)學(xué)意義(均P0.05);術(shù)后第三天P組、C組CD3-CD16+CD56+與術(shù)前比較均顯著下降,差異有統(tǒng)計(jì)學(xué)意義(均P0.05),而P組術(shù)后第3天CD3-CD16+CD56+較C組明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05);C組術(shù)后第3天CD3+CD4+/CD3+CD8+較術(shù)前增高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組細(xì)胞因子變化:IL-4:C組T4、T5時(shí)間點(diǎn)IL-4水平較T1時(shí)間點(diǎn)明顯降低,P組T6時(shí)間點(diǎn)IL-4水平明顯較各時(shí)間點(diǎn)明顯降低,差異有統(tǒng)計(jì)學(xué)意義(均P0.05);P、C兩組比較,C組T5時(shí)間點(diǎn)IL-4表達(dá)水平明顯低于P組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);P組T6時(shí)間點(diǎn)IFN-γ表達(dá)水平明顯較T2、T3和T4時(shí)間點(diǎn)升高(均P0.05),其余時(shí)間點(diǎn)比較差異無統(tǒng)計(jì)學(xué)意義(均P0.05)。TGF-β1組內(nèi)、組間比較,差異均無統(tǒng)計(jì)學(xué)意義(均P0.05)結(jié)論:低中心靜脈壓組IL-4的變化更明顯;低中心靜脈壓組對免疫功能有保護(hù)作用。
[Abstract]:Objective: to investigate the effect of low central venous pressure (Low central venous pressure,LCVP) on perioperative immune function in patients with liver cancer. Methods: a prospective study was carried out in 40 patients with hepatocellular carcinoma (HCC) diagnosed preoperatively and underwent partial hepatectomy from October 2016 to January 2017. According to the random number method, the patients were divided into two groups: control group (P group: traditional liquid management method, CVP maintained in 6-12cmH2O) and controlled descending CVP group (C group: limiting fluid input velocity, maintaining CVP at 3-5cmH2O during hepatic portal occlusion), 20 cases in each group. The two groups were given the same anesthesia and operation. Before induction 3min (T 1), after induction 3min (T 2), before hepatic hilus occlusion or before controlled CVP 3min (T 3), after hepatectomy 3min (T 4). Hemodynamics was recorded at the end of operation (T5) and 24 hours after operation (T6). Transfusion volume, blood loss, urine volume and blood transfusion were recorded at the end of operation. The concentration of serum interleukin (IL)-4, interferon (IFN)-緯 and transcription growth factor (TGF)-尾 1 were detected by enzyme linked immunosorbent assay (Elisa). The level of hepatic transaminase (ALT,AST) and immune function were measured before and after operation. Results: the changes of hemodynamics in two groups: at T4 time point, heart rate in group C was higher than that in group P, the difference was statistically significant (P0.05). The mean arterial depression in group C was significantly lower than that in group P (P0.05), but all fluctuated within the normal range of values, and there was no significant difference in other time points during operation (P0.05). Comparison of two groups of liquid management: C group total infusion, total blood loss, total blood transfusion and urine volume were lower than P group, the difference was statistically significant (P0.05). The changes of ALT and AST in the two groups: there was no significant difference in ALT and AST between the two groups before operation and on the third day after operation (P0.05), but the ALT and AST of the two groups on the 3rd day after operation were significantly higher than those of the preoperative basic value (P0.05). The changes of immune function in the two groups: the humoral immune IgG,IgM and IgA were significantly decreased 3 days after operation (P0.05), and the level of IgG,IgM,IgA was higher than that of the control group (P0.05). The difference was not statistically significant (P0.05). There was no significant difference in CD3, CD3 CD4, CD3 CD8, CD19 between the two groups on the 3rd day after operation (P0.05). On the third day after operation, CD3-CD16 CD56 in group P and group C were significantly decreased compared with those before operation (P0.05), while CD3-CD16 CD56 in group P was significantly lower than that in group C on the third day after operation (P0.05). The ratio of CD3 CD4 / CD3 CD8 in group C was significantly higher than that before operation on the 3rd day after operation (P0.05). The changes of cytokines in two groups: the level of IL-4 in IL-4:C group was significantly lower than that at T1 time point, and the IL-4 level at T6 time point in P group was significantly lower than that at each time point (P0.05). The expression of IL-4 in group C was significantly lower than that in group P at T5 time point (P0.05). The expression of IFN- 緯 at T6 time point in P group was significantly higher than that at T 2 T 3 and T 4 time points (P0.05), but there was no significant difference in other time points (P 0.05). There was no significant difference (P0.05) conclusion: the change of IL-4 was more obvious in low central venous pressure group. Low central venous pressure group had protective effect on immune function.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614;R735.7
本文編號(hào)：2305455
[Abstract]:Objective: to investigate the effect of low central venous pressure (Low central venous pressure,LCVP) on perioperative immune function in patients with liver cancer. Methods: a prospective study was carried out in 40 patients with hepatocellular carcinoma (HCC) diagnosed preoperatively and underwent partial hepatectomy from October 2016 to January 2017. According to the random number method, the patients were divided into two groups: control group (P group: traditional liquid management method, CVP maintained in 6-12cmH2O) and controlled descending CVP group (C group: limiting fluid input velocity, maintaining CVP at 3-5cmH2O during hepatic portal occlusion), 20 cases in each group. The two groups were given the same anesthesia and operation. Before induction 3min (T 1), after induction 3min (T 2), before hepatic hilus occlusion or before controlled CVP 3min (T 3), after hepatectomy 3min (T 4). Hemodynamics was recorded at the end of operation (T5) and 24 hours after operation (T6). Transfusion volume, blood loss, urine volume and blood transfusion were recorded at the end of operation. The concentration of serum interleukin (IL)-4, interferon (IFN)-緯 and transcription growth factor (TGF)-尾 1 were detected by enzyme linked immunosorbent assay (Elisa). The level of hepatic transaminase (ALT,AST) and immune function were measured before and after operation. Results: the changes of hemodynamics in two groups: at T4 time point, heart rate in group C was higher than that in group P, the difference was statistically significant (P0.05). The mean arterial depression in group C was significantly lower than that in group P (P0.05), but all fluctuated within the normal range of values, and there was no significant difference in other time points during operation (P0.05). Comparison of two groups of liquid management: C group total infusion, total blood loss, total blood transfusion and urine volume were lower than P group, the difference was statistically significant (P0.05). The changes of ALT and AST in the two groups: there was no significant difference in ALT and AST between the two groups before operation and on the third day after operation (P0.05), but the ALT and AST of the two groups on the 3rd day after operation were significantly higher than those of the preoperative basic value (P0.05). The changes of immune function in the two groups: the humoral immune IgG,IgM and IgA were significantly decreased 3 days after operation (P0.05), and the level of IgG,IgM,IgA was higher than that of the control group (P0.05). The difference was not statistically significant (P0.05). There was no significant difference in CD3, CD3 CD4, CD3 CD8, CD19 between the two groups on the 3rd day after operation (P0.05). On the third day after operation, CD3-CD16 CD56 in group P and group C were significantly decreased compared with those before operation (P0.05), while CD3-CD16 CD56 in group P was significantly lower than that in group C on the third day after operation (P0.05). The ratio of CD3 CD4 / CD3 CD8 in group C was significantly higher than that before operation on the 3rd day after operation (P0.05). The changes of cytokines in two groups: the level of IL-4 in IL-4:C group was significantly lower than that at T1 time point, and the IL-4 level at T6 time point in P group was significantly lower than that at each time point (P0.05). The expression of IL-4 in group C was significantly lower than that in group P at T5 time point (P0.05). The expression of IFN- 緯 at T6 time point in P group was significantly higher than that at T 2 T 3 and T 4 time points (P0.05), but there was no significant difference in other time points (P 0.05). There was no significant difference (P0.05) conclusion: the change of IL-4 was more obvious in low central venous pressure group. Low central venous pressure group had protective effect on immune function.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614;R735.7
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