罗哌卡因硬膜外阻滞对T细胞亚群、NK细胞及免疫球蛋白的影响

目的观察无手术应激情况下罗哌卡因硬膜外阻滞对T细胞亚群、NK(natural killer)细胞及免疫球蛋白的影响。方法下腹或下肢手术病人45例,硬膜外穿刺后随机分为三组:H组,高浓度(1%罗哌卡因)组;L组,低浓度(0.5%罗哌卡因)组;N组,对照组,给以试验剂量和相同容量的生理盐水。应用流式细胞术和免疫扩散法测定阻滞前、阻滞后30min、60min、90min外周静脉血T细胞亚群、NK细胞及免疫球蛋白。结果与阻滞前比较,H组30min、60min时CD4 和(CD3 CD4 )/(CD3 CD8 )值显著升高(P<0.05),90min差异不显著(P>0.05);H和L组与阻滞前比较,30、60min时NK细胞显著降低(P<0.05),90min时差异不显著(P>0.05);各组免疫球蛋白IgG、IgA、IgM阻滞前后无显著变化(P>0.05)。结论无手术应激情况下罗哌卡因硬膜外阻滞对细胞免疫功能产生轻微、可逆的抑制作用,对体液免疫功能无影响。

The Effects of Epidural Block with Ropivacaine on T-lymphocyte Subsets, Natural-Killer Cell and Immunoglobulin

Objective This paper is to observe the effects of epidural blocked with ropivacaine on T-lymphocyte subsets,natural-killer cell and munoglobulin-IgG,IgA,IgM in the condition of no stress of operation.Methods 45 patients requiring epidural anesthesia for inferior belly or lower extremity surgery were randomly divided into three groups: Group H blocked with high concentration local anesthetic(1% ropivacaine) Group L blocked with low concentration local anesthetic(0.5% ropivacaine) and Group N-the control group blocked with only testing dose and identical Saline.Before given testing dose(pre-block) and 30 min,60 min,90 min after blocking level stabilized(post-block),venous blood samples were taken from three groups to determinate the T-lymphocyte subsets-CD3 ,CD4 ,CD8 ,(CD3 CD4 )/(CD3 CD8 ),natural-killer cell CD 16 56 with flow cytometer and immunoglobulin-IgG,IgA,IgM by immunodiffusion technique.Results Variance of T-lymphocyte subsets: In group H,CD4 and(CD3 CD4 )/(CD3 CD8 ) increased significantly at 30 min,60 min of post-block(P<0.05) and were not different significantly at 90 min(P>0.05),CD 3 and CD 8 had no significant changes at each time point(P>0.05).The changes of T-lymphocyte subsets in group L and N were no significant contrast to pre-block(P>0.05);Variance of natural-killer cell: Contrast to pre-block,natural killer cell decreased significantly at 30 min and 60 min in group H and L(P<0.05),it had no significant difference at 90 min(P>0.05).Variances at each time point in group N were not significant(P>0.05).The variances between group H and L at each time point were not significant(P>0.05).Variance of immunoglobulin: IgG,IgA,IgM of all three groups had no significant changes at each point of post-block.Conclusions Epidural block with ropivacaine produced sligh,reversible effect on cellular immunity in the condition of no stress of operation,but not on humoral immunity.