非气管插管胸腔镜手术对体液免疫的影响
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摘要
目的通过非气管插管和气管插管下胸腔镜手术对体液免疫影响的比较,了解非气管插管胸腔镜手术的免疫优势。方法将2015年1月—2017年5月间在广西医科大学第四附属医院行胸腔镜手术的患者118例根据知情选择分成非气管插管麻醉组(48例)和气管插管麻醉组(70例),比较2组患者术前1天及术后第1天、第3天和第7天免疫球蛋白IgG、IgM、IgA及补体C3、C4和CRP水平的差异。分别于术前1天及术后第1天、第3天和第7天的清晨7时采集患者肘前外周血10 mL并即刻送检。通过免疫悬浊计测定IgG、IgM、IgA及补体C3、C4和C反应蛋白(CRP),检测所采用的试剂盒均由上海复星长征医学科学有限公司提供。数据采用SPSS 18.0统计软件进行统计处理,以P<0.05为差异有统计学意义。结果术后,除CRP水平升高外,其他指标均有不同程度的降低。术后1、3、7 d,2组患者IgA、IgG、补体C3、C4比较,t值分别为1.746、 0.899、1.342、1.775、1.440、1.779、0.192、0.633、0.242、0.931、0.996、0.741,差异均无统计学意义(均P>0.05);术后1、3 d,非气管插管下胸腔镜组IgM水平显著高于气管插管下胸腔镜组,t值为2.868和2.930(P<0.05);术后1、3 d,非气管插管下胸腔镜组CRP水平显著低于气管插管下胸腔镜组,t值为4.952和3.271(P<0.05)。结论与气管插管下胸腔镜手术相比,非气管插管下胸腔镜手术更具有体液免疫的优势。
Objective To understand the immune advantages of non-tracheal intubation video-assisted thoracoscopic surgery(VATS) by comparing with influence of tracheal intubation for VATS on the humoral immunity. Methods Between January 2015 to May 2017, 118 patients undergoing VATS in our hospital were assigned into two groups according to non-tracheal intubation anesthesia group(group A, n=48) and tracheal intubation anesthesia group(group B, n=70) according to the patient's informed choice. Ten mL of peripheral blood was prepared at 1 day before the surgery, and 1 day, 3 days and 7 days after the surgery for the measurement of IgA, IgG, IgM, CRP, C3 and C4 by using immunoturbidimetric assay. The results between the two groups were compared by using SPSS 18.0 for statistical data processing and statistical analysis. P<0.05 was considered to be statistically significant. Results After the operation, the levels of all the immunoprotein reduced in different degree, except for CRP. There were no significance on IgA, IgG, C3, C4 level between the two groups on D1, D3 and D7(all P>0.05, t=1.746, 0.899, 1.342, 1.775, 1.440, 1.779, 0.192, 0.633, 0.242, 0.931, 0.996, 0.741, respectively). The level of IgM on D1 and D3 after the surgery in the non-tracheal intubation anesthesia group was significantly higher than that in tracheal intubation anesthesia group(P<0.05, t=2.868, 2.930), however, the level of CRP in the non-tracheal intubation anesthesia group was significantly lower than that tracheal intubation anesthesia group(P<0.05, t=4.952, 3.271). Conclusion When compared with tracheal intubation anesthesia, non-tracheal intubation VATS can decrease the postoperative humoral immune response.
Objective To understand the immune advantages of non-tracheal intubation video-assisted thoracoscopic surgery(VATS) by comparing with influence of tracheal intubation for VATS on the humoral immunity. Methods Between January 2015 to May 2017, 118 patients undergoing VATS in our hospital were assigned into two groups according to non-tracheal intubation anesthesia group(group A, n=48) and tracheal intubation anesthesia group(group B, n=70) according to the patient's informed choice. Ten mL of peripheral blood was prepared at 1 day before the surgery, and 1 day, 3 days and 7 days after the surgery for the measurement of IgA, IgG, IgM, CRP, C3 and C4 by using immunoturbidimetric assay. The results between the two groups were compared by using SPSS 18.0 for statistical data processing and statistical analysis. P<0.05 was considered to be statistically significant. Results After the operation, the levels of all the immunoprotein reduced in different degree, except for CRP. There were no significance on IgA, IgG, C3, C4 level between the two groups on D1, D3 and D7(all P>0.05, t=1.746, 0.899, 1.342, 1.775, 1.440, 1.779, 0.192, 0.633, 0.242, 0.931, 0.996, 0.741, respectively). The level of IgM on D1 and D3 after the surgery in the non-tracheal intubation anesthesia group was significantly higher than that in tracheal intubation anesthesia group(P<0.05, t=2.868, 2.930), however, the level of CRP in the non-tracheal intubation anesthesia group was significantly lower than that tracheal intubation anesthesia group(P<0.05, t=4.952, 3.271). Conclusion When compared with tracheal intubation anesthesia, non-tracheal intubation VATS can decrease the postoperative humoral immune response.
引文
[1] 毛恩强,陈影.免疫功能障碍与围手术期感染[J].中国实用外科杂志,2016,36(2):175-178.
[2] 赵永静.支原体肺炎患儿细胞免疫和体液免疫功能的变化分析[J].医药论坛杂志,2016,37(2):142-143.
[3] 姚东.肺癌患者外周血淋巴细胞亚群变化研究[J].中国公共卫生管理,2017,33(2):288-290.
[4] 翁贤武,梁诚之,林培锋,等.单孔胸腔镜治疗早期非小细胞肺癌的临床疗效分析[J].中华全科医学,2017,15(6):977-979.
[5] 张伟,于在诚.食管癌患者不同术式围手术期细胞免疫与体液免疫的监测分析[J].广东医学,2015,36(10):1545-1547.
[6] 常炜,车勇,关小军,等.电视胸腔镜手术与后外侧开胸术对肺结核患者免疫功能影响[J].新疆医学,2017,47(6):579-584.
[7] 刘忠虎.双腔支气管插管在胸外科手术麻醉中的应用[J].黑龙江医药,2016,29(6):1234-1236.
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[10] 代小探,宋平平,张百江.非气管插管在胸外科VATS中的应用[J].中国肺癌杂志,2016,19(5):312-316.
[11] 陈曦,史建国.非气管插管胸腔镜手术治疗进展[J].现代医学,2015,43(7):928-930.
[12] 李树本.自主呼吸麻醉肺减容术对非均质性肺气肿犬呼吸生理和气道炎症影响的研究[D].广州:南方医科大学,2015.
[13] 周程,朱华东,陶红蕾,等.气管插管麻醉与下呼吸道感染的相关性研究[J].中华医院感染学杂志,2014,24(3):670-671.
[14] LIU J,CUI F,POMPEO E,et al.The impact of non-intubated versus intubated anaesthesia on early outcomes of video-assisted thoracoscopic anatomical resection in non-small-cell lung cancer:a propensity score matching analysis[J].Eur J Cardiothorac Surg,2016,50(5):920-925.
[15] 李晓亮,谢晓阳,杨彦辉,等.全胸腔镜与后外侧开胸手术对非小细胞肺癌患者创伤指标、免疫功能及生活质量的影响[J].临床肺科杂志,2017,22(7):1189-1191.
[16] 宋津津.腹腔镜子宫切除术对机体免疫球蛋白IgG、补体C3和C反应蛋白的影响和意义[D].泰安:泰山医学院,2013.
[2] 赵永静.支原体肺炎患儿细胞免疫和体液免疫功能的变化分析[J].医药论坛杂志,2016,37(2):142-143.
[3] 姚东.肺癌患者外周血淋巴细胞亚群变化研究[J].中国公共卫生管理,2017,33(2):288-290.
[4] 翁贤武,梁诚之,林培锋,等.单孔胸腔镜治疗早期非小细胞肺癌的临床疗效分析[J].中华全科医学,2017,15(6):977-979.
[5] 张伟,于在诚.食管癌患者不同术式围手术期细胞免疫与体液免疫的监测分析[J].广东医学,2015,36(10):1545-1547.
[6] 常炜,车勇,关小军,等.电视胸腔镜手术与后外侧开胸术对肺结核患者免疫功能影响[J].新疆医学,2017,47(6):579-584.
[7] 刘忠虎.双腔支气管插管在胸外科手术麻醉中的应用[J].黑龙江医药,2016,29(6):1234-1236.
[8] MURPHY G S,SZOKOL J W,AVRAM M J,et al.Postoperative residual neuromuscular blockade is associated with impaired clinical recovery[J].Anesth Analg,2013,117(1):133-141.
[9] 何建行.微创伤胸外科手术历史、现状和未来[J].国际病理科学与临床杂志,2013,33(1):1-7.
[10] 代小探,宋平平,张百江.非气管插管在胸外科VATS中的应用[J].中国肺癌杂志,2016,19(5):312-316.
[11] 陈曦,史建国.非气管插管胸腔镜手术治疗进展[J].现代医学,2015,43(7):928-930.
[12] 李树本.自主呼吸麻醉肺减容术对非均质性肺气肿犬呼吸生理和气道炎症影响的研究[D].广州:南方医科大学,2015.
[13] 周程,朱华东,陶红蕾,等.气管插管麻醉与下呼吸道感染的相关性研究[J].中华医院感染学杂志,2014,24(3):670-671.
[14] LIU J,CUI F,POMPEO E,et al.The impact of non-intubated versus intubated anaesthesia on early outcomes of video-assisted thoracoscopic anatomical resection in non-small-cell lung cancer:a propensity score matching analysis[J].Eur J Cardiothorac Surg,2016,50(5):920-925.
[15] 李晓亮,谢晓阳,杨彦辉,等.全胸腔镜与后外侧开胸手术对非小细胞肺癌患者创伤指标、免疫功能及生活质量的影响[J].临床肺科杂志,2017,22(7):1189-1191.
[16] 宋津津.腹腔镜子宫切除术对机体免疫球蛋白IgG、补体C3和C反应蛋白的影响和意义[D].泰安:泰山医学院,2013.
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