术中体温调控对肿瘤患者免疫功能的影响-中华麻醉在线.doc

术中保温对胃癌患者免疫功能的影响 林学正 彭从斌 周春莲 【摘要】 目的 观察术中保温对胃癌患者术后细胞免疫功能的影响。方法 择期行胃癌根治术患者40例，随机分为保温组（W组)和未保温组（N组），每组20例。采用流式细胞检测技术检测麻醉诱导前（T0）、术后2 h（T1）、术后4 d（T2）、术后7 d（T3）患者外周血T淋巴细胞亚群及Th细胞亚群。结果 与T0比较，两组T1时CD4+ 淋巴细胞百分率、CD4+/CD8+比值均下降（P0.01）P0.01或P0.05），W组T1时Th1细胞百分率下降（P0.05）；与W组比较，N组T1、T2时Th1细胞百分率降低（P0.05）。结论 术中低体温可抑制肿瘤患者的细胞免疫功能，其主要影响Th细胞的分化；保持正常的体温有利于保护肿瘤患者的细胞免疫功能，改善免疫状态。 【关键词】体温 细胞免疫 胃切除术 Effects of intraoperative maintenance of normal body temperature on the cell mediated immunity of gastric cancer patients LIN Xuezheng, PENG Congbin, ZHOU Chunlian. Taizhou Hospital, Linhai 317000, China 【Abstract】 Objective To the effects of intraoperative maintenance of normal body temperature on the cell mediated immunity of gastric cancer patients. Methods Forty patients scheduled for gastric cancer radical surgery were randomly divided into two groups (n=20 each): warming groop (W) and no warming groop (N). Patients of the groop W were warmed with circulating water mattress warmer and fluid warming device. Blood samples were taken from peripheral vein before induction (T0, baseline), at 2 h（T1） and 4 d（T2）, 7 d（T3） after operation for determination of subsets of T-lymphocyte CD4+, CD8+ and subsets of helper lymphocyte Th1, Th2 by flow cytometer. Results The subsets of T-lymphocyte CD4+ and the ratio of CD4+/CD8+ were significantly decreased at T1 as compared to the baseline at T0 in both groop W and groop N. In group N, Th1 and Th1/Th2 were significantly decreased at T1 and T2. In group W, Th1 was significantly decreased at T1. In group N, Th1 was significantly lower than in group W. Conclusion Intraoperative hypothermia impairs cell mediated immunity of gastric cancer patients. Maintenance of normal body temperature during operation is necessary for protection of immune function of patients. 【Key words】Body temperaturemmunity Gastrectomy 低体温是指中心体温低于36℃，是围手术期最为常见的体温失衡现象，是全身麻醉对体温调节功能的抑制以及手术室环境温度共同作用的结果。近年来的研究发现，低体温可以使术后的感染率明显增加[1,2]，其机制可能与低体温状态使机体的免疫功能受到抑制有关。恶性肿瘤患者的免疫功能下降可促使肿瘤复发和转移，从而