针刺复合小剂量硬膜外麻醉对胆囊摘除术患者外周血T淋巴细胞免疫功能的影响

目的：研究胆囊摘除术患者围手术期外周血T淋巴细胞亚群的变化。采用针刺复合小剂量硬膜外麻醉进行胆囊切除术以探讨针刺镇痛对免疫功能的效应。方法：选择胆囊炎胆石症患者20例，针刺复合小剂量硬膜外麻醉组（简称I组）和小剂量硬膜外麻醉组（简称Ⅱ组）各10例。针刺取左右内关、足三里穴，连接韩氏刺激仪，频率2／15Hz，疏密波，刺激量以病人耐受为宜。硬膜外麻醉剂为1．5％利多卡因5mL，并按4mL／次酌情追加。两组均于手术前、手术中和手术后第五天采外周血2mL，分离淋巴细胞，用免疫细胞化学染色法染色，检测淋巴细胞亚群，并测定健康成年人10例外周血T淋巴细胞亚群作对照组。结果：①麻醉前，Ⅰ、Ⅱ组患者T淋巴细胞亚群与对照组相比CD3^ 、CD4^ 、CD8^ 细胞数和CD4^ /CD8^ 比值均无统计学差异。②术中Ⅰ、Ⅱ组相比，前者T细胞亚群高于后者，有显著差异（P＜0．05）。③术后第五天，I组T细胞亚群高于Ⅱ组，有显著差异（P＜0．05）。④I组组内比较：手术前与手术中、手术中、手术后第五天比较，CD3^ 、CD4^ 、CD8^ 细胞数及CD4^ /CD8^ 比值无明显差异。⑤Ⅱ组组内比较：手术前与手术中、手术后第五天比较，各细胞数均有所降低但无统计学意义，唯独CD4^ 下降比较明显（P＜0．05）。结论：小剂量硬膜外麻醉，可能由于手术创伤和麻醉使CD4^ 细胞数下降，免疫功能受抑制，提示易发术后感染。针刺复合小剂量硬膜外麻醉，在围手术期，T细胞亚群的细胞数与比值均无明显改变。说明针刺除有加强镇痛作用减少麻醉用量外，可能还能加强细胞免疫功能，对于术后有抵御微生物感染作用。

Changes of Peripheral Blood T-lymphocytc Immune Function in Cholecystectomy Patients Undergoing Acupuncture Anesthesia Combined with Epidural Administration of Small Dose of Anesthetics

Objective: To observe changes of T lymphocyte subgroups in the peripheral blood in cholecystectomy patients undergoing acupuncture anesthesia combined with epidural administration of small dose of anesthetics for studying the effect of acupuncture analgesia on the immuno functional activity. Methods: A total 20 cases of cholecystitis plus cholelithiasis patients were randomly divided into acupuncture combined with epidural anesthesia (ACEA) group (n=10) and epidural anesthesia (EA) group (n=10). Blood samples (2 mL/time) were collected from the peripheral vein before, during and on the 5th day after operation for isolating lymphocytes that were stained with immunocytochemical technique. For comparison, blood samples of control group were collected from 10 cases of healthy people. Results: ① Before anesthesia, there were no significant differences among the 3 groups in the number of CD 3 +, CD 4 + and CD 8 + and the ratio of CD 4 + and CD 8 + (P>0.05). ② During operation, CD 3 +, CD 4 + and CD 8 + of ACEA group were obviously more than those of EA group (P<0.05). On the 5th day after operation, the number of CD 3 +, CD 4 + and CD 8 + of ACEA group was still obviously higher than that of EA group (P<0.05). ④ Comparison of CD 3 +, CD 4 + and CD 8 + and CD 4 + /CD 8 + before, during and after operation in ACEA group showed no significant differences, while in EA group, the number of T lymphocyte subgroups was decreased slightly, except for CD 4 +(P<0.05). Conclusion: Acupuncture could strengthen the analgesic effect of anesthetics, lower the dose of epidural anesthetics and raise lymphocyte mediated immunocompetence.