本文選題：七氟醚 + 胃癌��； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:當(dāng)今社會(huì)腫瘤的發(fā)病率日漸升高,手術(shù)是治療腫瘤患者的主要手段之一,患者良好的免疫功能會(huì)在很大程度上提高自身的存活率,人體外周血淋巴細(xì)胞的數(shù)目可反映人體免疫功能的高低,而圍術(shù)期的手術(shù)刺激、麻醉藥物以及麻醉方式都會(huì)影響患者的免疫功能。為了探究七氟醚麻醉對(duì)行腹腔鏡胃癌根治術(shù)的老年患者圍術(shù)期免疫功能的影響,我們觀察了七氟醚麻醉下行腹腔鏡胃癌根治的老年患者圍術(shù)期外周血淋巴細(xì)胞亞群數(shù)量的變化,從而探究七氟醚麻醉對(duì)老年胃癌患者圍術(shù)期免疫功能變化的影響。方法:通過我院倫理委員會(huì)批準(zhǔn),選擇19例2016年11月至2017年02月來自胃腸外科年齡在60~80歲之間的胃癌患者,ASA分級(jí)Ⅰ~Ⅱ級(jí),采用統(tǒng)一的給藥標(biāo)準(zhǔn)進(jìn)行麻醉誘導(dǎo)與維持,手術(shù)均為當(dāng)日首臺(tái)(8:00 AM),并由同一組外科大夫進(jìn)行。分別抽取患者麻醉誘導(dǎo)開始前10min(T1),麻醉誘導(dǎo)后5min(T2),手術(shù)開始即刻(T3),手術(shù)開始后30min(T4),手術(shù)結(jié)束所有維持藥物停藥即刻(T5),術(shù)后24小時(shí)(T6)以上六個(gè)時(shí)間點(diǎn)的外周血,采用流式細(xì)胞儀技術(shù)測定外周血中T淋巴細(xì)胞(CD3+)絕對(duì)值、B淋巴細(xì)胞(CD19+)絕對(duì)值、NK細(xì)胞(CD3-CD16+和/或CD56+)絕對(duì)值的變化,并且觀察記錄每一個(gè)時(shí)間點(diǎn)患者的血壓、心率、脈氧飽和度、BIS。結(jié)果:(1)患者生命體征變化:與麻醉誘導(dǎo)前10min(T1)相比,麻醉誘導(dǎo)后5min(T2)、手術(shù)開始即刻(T3),患者的血壓、心率、BIS均下降,P0.05,結(jié)果具有統(tǒng)計(jì)學(xué)意義。且T3與T2相比,T3時(shí)刻患者血壓、心率繼續(xù)下降,具有統(tǒng)計(jì)學(xué)意義。隨著麻醉與手術(shù)的進(jìn)行,手術(shù)結(jié)束所有維持藥物停藥即刻(T5)、手術(shù)后24小時(shí)(T6)患者心率、血壓恢復(fù)至術(shù)前水平,與術(shù)前相比無統(tǒng)計(jì)學(xué)意義。患者腦電雙頻指數(shù)(BIS)在麻醉誘導(dǎo)后5min(T2)開始下降,與T1時(shí)刻相比有統(tǒng)計(jì)學(xué)意義。在整個(gè)手術(shù)過程中,患者BIS值維持在較恒定的狀態(tài),T2、T3、T4時(shí)刻BIS值相互之間比較無統(tǒng)計(jì)學(xué)差異。在手術(shù)結(jié)束所有維持藥物停藥即刻(T5),患者的BIS值較T4時(shí)刻上升,有統(tǒng)計(jì)學(xué)意義。(2)患者外周血淋巴細(xì)胞亞群數(shù)量變化:與麻醉誘導(dǎo)前10min(T1)相比,患者誘導(dǎo)后5min(T2)、手術(shù)開始即刻(T3)用流式細(xì)胞儀測定的外周血T淋巴細(xì)胞(CD3+)絕對(duì)值、B淋巴細(xì)胞(CD19+)絕對(duì)值、NK細(xì)胞(CD3-CD16+和/或CD56+)絕對(duì)值均下降,P0.05,結(jié)果具有統(tǒng)計(jì)意義;T3與T2相比三種細(xì)胞絕對(duì)值下降,結(jié)果具有統(tǒng)計(jì)學(xué)意義。手術(shù)開始后30min(T4)與手術(shù)開始即刻(T3)相比三種細(xì)胞數(shù)量上升,有統(tǒng)計(jì)學(xué)意義,隨著手術(shù)的持續(xù)進(jìn)行,手術(shù)結(jié)束所有維持藥物停藥即刻(T5)與T4相比,外周血中三種免疫細(xì)胞數(shù)量明顯下降,P0.05,結(jié)果具有統(tǒng)計(jì)學(xué)意義;手術(shù)結(jié)束所有維持藥物停藥即刻(T5)與麻醉誘導(dǎo)前10min(T1)相比,外周血T淋巴細(xì)胞(CD3+)絕對(duì)值、B淋巴細(xì)胞(CD19+)絕對(duì)值均未能恢復(fù)至術(shù)前水平,P0.05,結(jié)果具有統(tǒng)計(jì)學(xué)意義;術(shù)后24h(T6)與術(shù)前(T1)相比,外周血T淋巴細(xì)胞(CD3+)絕對(duì)值、B淋巴細(xì)胞(CD19+)絕對(duì)值、NK細(xì)胞(CD3-CD16+和/或CD56+)絕對(duì)值均未能恢復(fù)至術(shù)前水平,P0.05,結(jié)果具有統(tǒng)計(jì)學(xué)意義。結(jié)論:七氟醚吸入麻醉會(huì)使老年胃癌患者外周血淋巴細(xì)胞數(shù)量下降,該抑制作用在麻醉誘導(dǎo)后即產(chǎn)生,且隨著吸入七氟醚時(shí)間延長及吸入量的增加而逐漸顯著;手術(shù)刺激會(huì)使老年胃癌患者外周血淋巴細(xì)胞亞群數(shù)量一過性上升,但隨著手術(shù)的進(jìn)行及麻醉時(shí)間的延長,外周血淋巴細(xì)胞各亞群數(shù)量均顯著下降,且在手術(shù)結(jié)束及術(shù)后24小時(shí)未能恢復(fù)至術(shù)前水平。
[Abstract]:Background: the incidence of tumor in the society is increasing day by day. Surgery is one of the main methods for the treatment of cancer patients. The good immune function of the patient will improve the survival rate to a great extent. The number of lymphocytes in the peripheral blood of the human body can reflect the body's immune function, and the perioperative stimulation, narcotic drugs and anaesthesia In order to explore the effects of sevoflurane anesthesia on the perioperative immune function of the elderly patients undergoing laparoscopic radical gastrectomy, we observed the changes in the number of peripheral blood lymphocyte subsets in the peri operative period of the elderly patients undergoing laparoscopic radical gastrectomy under sevoflurane anesthesia, thus exploring the sevoflurane anesthesia. The influence of the perioperative immune function changes in the elderly patients with gastric cancer. Methods: through the approval of our hospital ethics committee, 19 cases of gastric cancer from November 2016 to 02 months were selected from the gastrointestinal surgery age of 60~80 years old, ASA grade I ~ II grade, the uniform administration standard was used to induce and maintain the intoxication, the operation was the first stage of the day (8:00 AM). And by the same group of surgeons, 10min (T1) before induction of anesthesia induction, 5min (T2) after anesthesia induction, operation start immediately (T3), 30min (T4) after the operation, all maintenance drug withdrawal immediately (T5), and six time points above 24 hours (T6) after operation, and flow cytometry to determine peripheral blood. The absolute value of T lymphocyte (CD3+), the absolute value of B lymphocyte (CD19+), the absolute value of NK cells (CD3-CD16+ and / or CD56+), and observe the blood pressure, heart rate, pulse oxygen saturation and BIS. results at each time point: (1) the changes of vital signs: Compared with 10min (T1) before induction of anesthesia, 5min (T2) after induction of anesthesia, operation begins immediately T3, the patient's blood pressure, heart rate, BIS decreased, P0.05, and the results were statistically significant. And T3 and T2, the blood pressure, heart rate continued to decline, with statistical significance. With the anesthesia and operation, all the maintenance drugs were stopped immediately after the operation (T5), the heart rate of the 24 hours (T6) after the operation, the blood pressure was restored to the preoperative level, There was no statistical significance compared with preoperative. The bispectral index (BIS) of the patients began to decrease after the induction of 5min (T2) after anesthesia induction, and was statistically significant compared with the time of T1. During the whole operation, the patient's BIS value remained at a relatively constant state, and there was no statistical difference between T2, T3, and T4 at the time of the operation. All drug withdrawal at the end of the operation Immediately (T5), the BIS value of the patient was higher than that of T4. (2) the number of lymphocyte subsets in the peripheral blood of the patients: compared with 10min (T1) before induction of anesthesia, the patients were induced to 5min (T2), and the absolute value of T lymphocyte (CD3+), B lymphocyte (CD19+), was measured by flow cytometry. The absolute value of -CD16+ and / or CD56+) decreased, P0.05, and the results were statistically significant. Compared with T2, the absolute values of the three cells decreased and the results were statistically significant. After the operation, the number of three cells increased in 30min (T4) compared with the operation beginning immediately (T3), with statistical meaning, with the operation continuing, all the maintenance drugs were stopped at the end of the operation. Compared with T4, the number of three immune cells in peripheral blood decreased significantly in peripheral blood, P0.05, and P0.05, and the results were statistically significant. The absolute value of T lymphocyte (CD3+) in peripheral blood (CD3+) and B lymphocyte (CD19+) were not recovered to the preoperative level, P0.05, the result of all the maintenance drug withdrawal (T5) and 10min (T1) before the anesthesia induction. The absolute value of T lymphocyte (CD3+) in peripheral blood, B lymphocyte (CD19+) absolute value, NK cell (CD3-CD16+ and / or CD56+) absolute values were not recovered to preoperative level, P0.05, and the results were statistically significant. Conclusion: sevoflurane inhalation anesthesia will make peripheral blood lymphatic in elderly patients with gastric cancer. Conclusion: 24h (CD3+) absolute value of peripheral blood (CD3+), B lymphocyte (CD19+) absolute value, NK cells (CD3-CD16+ and / or CD56+) can not be recovered to the preoperative level, P0.05, and the results are statistically significant. The number of cells decreased, the inhibitory effect was produced after anesthesia induction, and gradually increased with the prolonged inhalation of sevoflurane and the increase of inhalation. The surgical stimulation would increase the number of lymphocyte subsets in the peripheral blood of the elderly patients with gastric cancer, but the number of lymphocyte subgroups in the peripheral blood with the operation and anesthesia time prolonged. The volume decreased significantly and failed to recover to the preoperative level at the end of operation and 24 hours after operation.

【學(xué)位授予單位】：大連醫(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;R735.2

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