Effects Of Different Hemodilution Techniques On Perioperative NK Cell,CIK Cell,Th₁/Th₂ Cytokines In Patients Undergoing Rectal Cancer Surgery

Objective To investigate effects of acute hypervolemic hemodilution(AHH) combined with controlled hypotension(CH),acute non-normolvolemic hemodilution (ANIH)and allogeneic RBC transfusion on NK cell,CIK cell,Th₁/Th₂ dependent cytokines in patients undergoing rectal cancer surgery.Methods Sixty ASA classificationâ… orâ…¡,TNM classificationâ…¡orâ…¢patients aged 45-65y,weighing 45-65 kg,undergoing rectal cancer surgery and were randomly allocated to three groups(n=20,each):Groupâ… ,allogenic RBC transfusion(control group),Groupâ…¡, acute non-normolvolemic hemodilution(ANIH)and Groupâ…¢,acute hypervolemic hemodilution(AHH)combined with controlled hypotension(CH).Groupâ… : allogeneic RBC 400ml transfusion to patients before the end of operation.Groupâ…¡: collecting autologous blood(approximately 10%of blood circulatory volume in patients' circulation)by radial artery before operation.During induction,infusing colloid fluid(hydroxyethly starch 130/0.4 sodium chloride injection)two times of the volume of collected autologous blood at the rate of 30ml/min,then reinfusion of autologous blood.Groupâ…¢:after anesthesia induction,infusing hydroxyethly starch 130/0.4 sodium chloride injection 20%of own-blood volume in 30min,meanwhile controlling hypotension by intravenous infusion of glyceryl trinitrate.MAP was maitained 60-65imnHg.During Operation,heart rate increased more than 20%of the baseline value,controlling it by bolus injection of esmolot(5-10mg).The venous blood samples were taken at 4 time points which were at 1 h before the anesthesia(T₁),at the first hour after surgery(T₂),on the first day and the forth day after surgery(T₃,T₄) to measure NK cell,CIK cell and cytokines(Th₁:IFN-γ,TNF-α,IL-2.Th₂:IL-4,IL-5,IL-10)by flow cytometry,meanwhile observing the variant tendency of Th₁-/Th₂-dependent cytokines ratios.Main Results There were no significant difference in age,body height,body weight,ASA classification,TNM classification, operation duration,VAS and RSS in three groups(p＞0.05).The variance of cytokines Compared with normal value,all cytokines in three groups were significantly increased,especially Th₂-dependent cytokines(p＜0.01),but there were no significant difference in three groups.The level of Th₁-dependent cytokines at T₄,were obviously increased in groupâ…¡,â…¢as compared to these at T₁(p＞0.05),especially IL-2 and TNF-α,but these in groupâ… decreased(p＜0.05),and there were significant difference in three groups(p＜0.05).Th₂-dependent cytokines:The level of plasma IL-5 at T₄ decreased as compared to that at T₁(p＜0.05),and lower in groupâ… than groupâ…¡(p＜0.05);The level of plasma IL-10 at T3 decreased compared to that at T₁ in groupâ…¡,â…¢(p＞0.05),but that in groupâ… increased(p＜0.05),and were significant difference with groupâ…¡and groupâ…¢(p＜0.05).At T₄,the level of plasma IL-10 in groupâ… still increased(p＞0.05),and higher than that in groupâ…¢(p＜0.05).Th₁-/Th₂-dependent cytokines ratios:Th₁-/Th₂-dependent cytokines ratios at T₄,decreased in groupâ… ,but obviously increased in groupâ…¡,â…¢,especially in groupâ…¢(p＜0.05),and there were significant difference between groupâ…¢and groupâ… (p＜0.05).NK cell:Compared with normal value,NK cell in three groups were obviously decreased(p＜0.05).Compared with that at T₁,NK cell in groupâ…¢increased(p＜0.05),and was higher than groupâ… and groupâ…¡at T₂(p＜0.05).At T₄, the level of NK cell in groupâ…¡,â…¢obviously increased,and higher than that in groupâ… (p＜0.05),CIK cell:The level of CIK Cell in groupâ… obviously decreased at T₂ compared to that at T₁(p＜0.05).At T₄,The level of CIK cell in groupâ…¡,â…¢significantly increased(p＞0.05),and there were significant difference between groupâ…¢and groupâ… (p＜0.05).Conclusion After allogenic RBC transfusion to patients undergoing rectal cancer surgery during perioperation,NKcell,CIK cell and Th₁-/Th₂-dependent cytokines ratios decreased;Acute hypervolemic hemodilution (AHH)combined with controlled hypotension(CH)and acute non-normolvolemic hemodilution(ANIH):the level of cytoactive,NK cell and elK cell were increased and Th₁-/Th₂-dependent cytokines ratios balance of patients undergoing rectal cancer surgery were improved,especially acute hypervolemic hemodilution(AHH) combined with controlled hypotension(CH);Acute hypervolemic hemodiiution (AHH)combined with controlled hypotension(ell)and acute non-normolvolemic hemodilution(ANIH)can be elected as blood conservation in patients undergoing rectal cancer surgery.