中文摘要：

目的通过比较2种麻醉方式对Th1和Th2类细胞因子表达的影响,探讨用于胃癌手术治疗的最佳麻醉方法,为临床麻醉管理提供参考依据。方法选择40例择期行胃癌根治术的患者,随机分为吸入麻醉组（S组）和静脉麻醉组（P组）,分别采用七氟烷和丙泊酚进行麻醉诱导和维持。收集患者一般资料,记录肿瘤组织分型,术中液体输注量和失血量。分别于术后1h、6h和5d记录患者VAS评分,并于麻醉诱导前（T1）、术后6h（T2）和术后5d（T3）抽取患者外周静脉血,采用ELISA法检测血浆IL-1β、IFN-γ、TNF-α、IL-2、IL-6和IL-10的水平,应用流式细胞仪检测CD3^＋CD8^-IFN-γ^＋和CD3^＋CD8^-IL-10^＋细胞,并计算Th1/Th2比值。结果与麻醉诱导前比较,S组和P组患者术后各时点血浆IL-6水平明显升高（均P〈0.05）,IL-1β、IL-2和IL-10水平无明显变化（均P〉0.05）。S组患者各时点血浆TNF-α、IFN-γ水平及Th1/Th2比值无明显变化（均P〉0.05）,P组患者术后第5天时TNF-α、IFN-γ水平及Th1/Th2比值明显升高（均P〈0.05）。结论丙泊酚全凭静脉麻醉可增强患者的Th1细胞反应,是胃癌根治术患者较为理想的麻醉选择。

英文摘要：

Objective To explore the optimal method of anesthesia in radical resection of gastric cancer by comparing the effects of two anesthesia techniques on the balance of Th1/Th2 in order to provide evidence for clinical anesthesia management.Methods Forty patients who underwent elective radical resection of gastric cancer were randomized into two groups：inhalation anesthesia group（group S）and total intravenous anesthesia group（group P）,in which sevoflurane and propofol were administered for the induction and maintenance of anesthesia,respectively.The general data of the patients were collected,the tissue type of tumors obtained and the fluid infusion and blood loss volumes recoded.The VAS score was obtained 1h,6hand 5d after the surgery.Before the induction of anesthesia,6hand 5dafter surgery,the blood samples were drawn to determine the serum levels of IL-1β,IFN-γ,TNF-α,IL-2,IL-6and IL-10.Flow cytometry was used to detect the proportion of CD3^＋CD8^-IFN-γ^＋and CD3^＋CD8^-IL-10^＋cells and the Th1/Th2 ratio was calculated.Results The level of IL-6was increased post-surgically in groups S and P（P〈0.05）.There were no significant changes in the levels of IL-1β,IL-2and IL-10 in groups S and P and in the levels of TNF-αand IFN-γ,and the Th1/Th2 ratio in group S between before the induction of anesthesia and different time points after the surgery（P〈0.05）.The levels of TNF-αand IFN-γ,and the Th1/Th2 ratio were significantly increased in group P 5dafter the surgery（P〈0.05）.Conclusion Total intravenous anesthesia with propofol can enhance Th1 response and it is an ideal anesthetic method for radical resection of gastric cancer.