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Effects of Different Anesthesia and Analgesia on T Lymphocyte Subsets and the Differentiation of T Helper Lymphocytes in the Esophageal Carcinoma Patients Undergoing Thoracic Surgery

Author: PanXiongXiong
Tutor: QianYanNing
School: Nanjing Medical University
Course: Anesthesiology
Keywords: Anesthesia method Analgesia Thoracic epidural anesthesia T lymphocyte subsets Differentiation of T helper lymphocytes
CLC: R614
Type: Master's thesis
Year: 2008
Downloads: 145
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Abstract


Objective: To investigate the effects of different anesthesia and analgesia on T lymphocyte subsets and the differentiation of T helper lymphocytes in the esophageal carcinoma patients undergoing thoracic surgery, and to explore the possibility of corresponding mechanism.Methods: Sixty esophageal carcinoma patients, classified as ASA physical statusⅠ-Ⅱ, scheduled for elective thoracic surgery were randomly divided into three groups with 20 cases each. In groupⅠ, patients received general anesthesia（TIVA） and patient-controlled intravenous analgesia （PCIA） postoperatively; patients in groupⅡreceived general anesthesia combined with thoracic epidural anesthesia （CGEA） during surgery and the same method of analgesia as groupⅠpostoperatively; In groupⅢpatients were anesthetized as well as those in groupⅡ, and received patient-controlled epidural analgesia（PCEA） postoperatively. Venous blood samples were taken before the induction of anesthesia（T0）, 2h after incision（T1）, 4h after the end of surgery （T2）, 24h after the end of surgery （T3） and 48h after the end of surgery （T4）. Pain intensity was assessed at T2, T3 and T4 with a box scale （0-10, where 0 is no pain and 10 is the worst pain ever） .The percentage of CD4+ T lymphocytes（CD4+）, CD8+ T lymphocytes（CD8+）, IFN-γ-producing T lymphocytes （Th1） and IL-4-producing T lymphocytes （Th2） were quantified by using flow cyto-metry. And the ratio of Th1/Th2 and CD4+/CD8+were calculated. Results: （1） Effects of analgesia The effects of postoperative pain control in all groups were satisfactory. However the VAS scores in groupⅡandⅢwere significantly lower than in groupⅠat T2（P <0.05）.And the VAS scores in groupⅢwere significantly lower than in groupⅠandⅡat T3（P<0.05）.（2）Changes of CD4+ and CD8+ T lymphocyte subsets The percentage of CD4+ and the CD4+/CD8+ ratios were similar before anesthesia among three groups. Compared with the values at T0, the percentage of CD4+ from T1 to T4 in groupⅠdecreased significantly, as well as the CD4+/CD8+ ratios at T2 and T4 （P <0.05）. The percentage of CD4+ and the CD4+/CD8+ ratios in groupⅡdecreased significantly at T3 and T4 （P <0.05）. However, the percentage of CD4+ and the CD4+/CD8+ ratios did not change over the period of the study in groupⅢ. The percentage of CD4+ in groupⅡfrom T1 to T3 were significantly higher than those in groupⅠ（P <0.05）. Although the CD4+/CD8+ ratios in groupⅡincreased significantly at T2 than that in groupⅠ（P <0.05）, there were no significant differences between groupⅠand groupⅡat any other postoperative time points （P> 0.05）. The percentage of CD4+ and the CD4+/CD8+ ratios in groupⅢwere significantly higher than those of groupⅡat T3 and T4 （P <0.05）.（3）Changes of T helper lymphocytes（Th） The percentage of Th1 and Th2, the ratio of Th1/Th2 had no significant difference among three groups（P>0.05）. The percentage of Th1 in all groups from T2 to T4 decreased significantly （P<0.05）. The ratio of Th1/Th2in groupⅠat T2 and T4, and that in groupⅡat T3 and T4 decreased significantly （P<0.05）. The percentage of Th2 in groupⅠand groupⅡfrom T2 to T4 were increased as well as that in groupⅢat T3（P<0.05）. The ratio of Th1/Th2in groupⅡandⅢwere higher than that in groupⅠat T2 （P<0.05）. The ratio of Th1/Th2 in groupⅢwere higher than those in groupⅡat T3 and T4（P<0.05）.Conclusion: The immune function of patients with esophageal cancer after thoracic surgery has been further inhibited, such as CD4+ T lymphocytes in the lower percentage, decrease of the CD4+/CD8+ ratios or the balance of Th1 and Th2 felling to the Th2 shift. These results suggested that general anesthesia combined with thoracic epidural anesthesia and PCEA may preserve the percentage of CD4+ T lymphocytes and the CD4+/CD8+ ratios in peripheral blood after operation, as well as inhibit the differentiation of precursor T helper cells （Th0） into Th2. Our data demonstrated that in the esophageal carcinoma patients undergoing thoracic surgery, general anesthesia combined with thoracic epidural anesthesia and PCEA is able to improve the cellular immune function.

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CLC: > Medicine, health > Surgery > Surgical operation > Anesthesiology
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