The Impact Of Perioperative Body Temperature Preservation On Cellular Immunity And MMP-9、VEGF In Patients Uundergoing Laparoscopic Radical Gastrectomy

Objective:To investigate the effect of perioperative body temperature preservation on core body temperature, CD3+, CD4+, CD8+, MMP-9 and VEGF in patients undergoing laparoscopic radical gastrectomy under general ansthesia,and assess the effects of active measure of body temperature preservation on immunologic function and the metastasis of neoplasm, so as to establish a sharp understanding of the importance of perioperative body temperature preservation.Methods:Eighty patients scheduled for laparoscopic radical gastrectomy, 18~65ys, ASAⅠ~Ⅱ, BMI 20~25kg/m2,were randomly divided into temperature preservatio n group(Group T) and control group(Group C). Forty cases for each group. Perioperatively the room temperature was controlled between 22~24 ℃,while the humidity between 40~60%. For Group T, comprehensive warming measures were provided once the patient get into the operating room: application of force-air warming blanket with 38 before anesthesia, and then adjust the te℃ mperature to 43 after induction. ℃All infusion was heated by a fluid warming device, all rinse fluid was applied at 37 ℃. And extremities were wrapped with cloth, while the target core body temperature was 37±0.5℃. In the control group, patients received routine surgical care, and all infusion and rinse fluid keep at room temperature. HR, MAP and tympanic tempera ture frecorded before anesthesia(T0), anesthesia induction(T1), 30min(T2), 90min(T3), 120min(T4), 180min(T5) after induction and at when operation was over(T6). The tympanic temperature was checked for three times each time. Blood samples were obtained before anesthesia(T0),1d(T7), 3d(T8) and 7d(T9) after operation, and CD3+, CD4+, CD8+ were tested with flow cytometry, serum MMP-9、VEGF were detected with enzyme-linked immuno sorbent assay(ELISA).Results:In group C, the temperature has trend down from 30 min after induction toclosure, and it was significantly lower when compaired with baseline and group T(P<0.05). CD3+, CD4+ and CD4+/CD8+ were higher in group T than those in group C, while both decreased in group T and group C when compaired with baseline in 1d and 3d after operation. And both returned to baseline 7 days postoperatively. Serum MMP-9、VEGF significantly increased in both groups after operation(P<0.05), while no difference was found in group C and group T(P>0.05).Conclusion:Perioperative temperature intervention may attenuate postoperative immune suppression in patients undergoing laparoscopic radical gastrectomy. Meanwhile, it dose not increase serum MMP-9 and VEGF, which may be indicate metastasis of neoplasm.