The Influence Of Different Methods Of Anesthesia On Immune Function In Patients Undergoing Radical Mammotomy

Objective This study was designed to investigate the effects of different methods of anesthesia on immune function during radical mammotomy. Methods Thirty-nine ASA Ⅰ ~ Ⅱ femal patients with breast cancer, scheduled for radical mammotomy, were randomly assigned to receive inhalation anesthesia (group Ⅰ, n=13), total intravenous anesthesia (TIVA)(group Ⅱ. n=13) and intravenous anesthesia combined with epidural anesthesia (group III, n=13). The patients were induced with midazolam0.1mg/kg, propfol1mg/kg and fentanyl4 μg/kg. After operation PICA with fentanyl 0.01mg/ml was started(background infusion 2ml · h-1, bolus 0.5ml, lock-out time 15min) in Ⅰ and Ⅱ groups. In groupⅢ, after operation PECA with 0.125% bupivacaine plus fentanyl 4μ g · l-1 was started (background infusion 2ml · h-1, bolus 0.5ml, lock-out time 15min). Blood samples were obtained from peripheral vein for determination of CD3+, CD4+, CD8+ ,CD4+/CD8+ ratio,NK cells and B lymphocute cells by flow cytometer before anesthesia(T0), at the end of operation (T1) and on the morning of post-operative day 1 and 3 and 7(T2.3,4). Results There were no significant changes in B lymphocyte cells among 3 groups. In 3 groups , CD3+, CD4+ and CD4+/CD8+ ratio measured at the end of operation decreased significantly (P<0.05, 0.01) as compared with the baseline values. 1 day after operation, In group Ⅱand group Ⅲ CD3+, CD4+and CD4+/CD8+ ratio increased and reached the baseline values,but in group I they were still lower (P<0.05) .3> 7 days after operation CD3+, CD4+and CD4+/CD8+ ratio reached the baseline values in 3 groups. In group Ⅰ CD3+ was significantly lower than that in group Ⅱ and group Ⅲ (P<0.05);and CD4+/CD8+ ratio as compared with group Ⅱ and group Ⅲ was also significantly lower (P<0.05). In group I there was significant decrease in NK cells measured on the morning of post-operation 3 days and 7 days (P<0.05), which was different as compared with group Ⅱand group Ⅲ(P<0.05). In group Ⅱ there was significant increase in NK cells measured at the end of operation (T1) (P<0.05) and NK cells returned to the baseline values 1 day after operation and unchanged till 7 days after operation. NK cells in group Ⅲ changed slightly (P>0.05) . Conclusion Intravenous anesthesia with propofol combined with epidural anesthesia has less effects on patients T-lymphocyte and NK cells during radical mammotomy, while single general anesthesia can inhibit patients immune function. Intravenous anesthesia with propofol combined fentanyl seems exert to less effect on immunefunction and stress than inhalation anesthetic.