目的:研究不同麻醉方法对外周血单核细胞mCD14与Toll样受体4(TLR4)表达的影响.方法:选择择期行结、直肠癌根治术患者,共24例,年龄18～65岁,性别不限;体质量指数(BMI)18～23 kg/m2;美国麻醉医师学会(ASA)I～II级.所有患者分为2组:单纯全麻组(GA组)和全麻复合硬膜外阻滞组(GA+E组),每组各12例.GA组以6 μg/kg芬太尼、1.5～2.0 mg/kg丙泊酚和0.6～0.8 mg/kg罗库溴铵行全麻诱导,术中以七氟醚维持麻醉,呼气末浓度维持在1.0～1.3最低肺泡有效浓度(MAC).GA+E组患者入手术室后于T12～L1穿刺并放置硬膜外导管,全麻诱导方法和药物同GA组,气管插管后硬膜外分次给予1%利多卡因及0.2%丁卡因混合液共9～12 mL,并维持呼气末七氟醚浓度在0.6～0.8 MAC,术中每小时追加1%利多卡因及0.2%丁卡因混合液3～4 mL.分别于手术前、手术开始(切皮)时、切皮后2 h及术后24 h采外周血测定单核细胞膜型CD14(mCD14)、Toll样受体4(Toll-like receptor 4,TLR4)数值.结果:GA+E组和GA组相比,患者各时间点单核细胞mCD14数值均无显著变化.GA组手术开始时单核细胞TLR4较术前显著下降(P<0.05),而GA+E组各时间点单核细胞TLR4无显著变化.结论:硬膜外阻滞可能通过影响TLR4的表达平衡手术应激产生的免疫抑制.%Objective: This study was designed to investigate the effects of different anaesthesia methods on expression of monocyte mCD14 and TLR4. Methods: A total of 24 ASA Ⅰ or Ⅱ, BMI 18-23kg/m2 , 18-65 year-old patients, who were scheduled for radical treatment of colon or rectum carcinoma were recruited in this study. They were randomly allocated to receive general anaesthesia (Group GA, n= 12) or general anaesthesia combined with epidural anaesthesia (Group GA+ E, n= 12). Patients in Group GA were induced with 1.5-2.0 mg/kg propofol and 6μg/kg fentanyl, and tracheal intubation was accomplished with 0. 6-0. 8mg/kg rocuronium.The anaesthesia was maintained with sevoflurane (end-tidal concentration 1.0-1.3MAC). Patients in Group GA + E were placed an epidural catheter at a vertebral interspace between T12 and L1. General anaesthesia was performed as Group GA. After administration 1 ％lidocaine and 0.2 ％ tetracaine 9-12ml, anaesthesia was maintained with sevoflurane, the end-tidal concentrations were 0.6-0. 8 mininum alveolar concentration(MAC), and epidural infusion of 1％ lidocaine and 0.2 ％ tetracaine 3-4ml/h. 2ml peripheral vein blood was collected from every patient before operation, at the beginning of operation, 2 hours after the beginning of operation and 24 hours after the end of operation, respectively. Perioperative express of monocyte mCD14 and Toil-like receptor 4 were measured. Results: Compared with Group GA + E, Group GA had no effects on the expression of monocyte mCD14 at different time points. Epidural anesthesia can prevent the depression of monocyte TLR4(P＜0. 05). Conclusions: Epidural anaesthesia may have benefitial effects on immune reaction and stress response induced by surgical stress.
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