摘要 目的 研究全身麻醉下患者围术期外周血白细胞数量和白细胞源性及血浆β-内啡肽含量变化。方法 选取48例年龄24-65岁、ASA Ⅰ-Ⅱ级患者，静脉全身麻醉下行择期手术。记录围术期外周血白细胞（white blood cell，WBC）总数及分类计数。于麻醉开始前（T1）、麻醉结束患者清醒后（T2）采集肘静脉血4ml，流式细胞术检测白细胞中-内啡肽（β-endorphin, β-EP）荧光阳性细胞百分数和平均荧光强度（mean fluorescence intensity, MFI），放射免疫分析法（radioimmunoassay, RIA）测定血浆β-EP水平。结果 术后WBC总数（10.80±3.39）×109/L增加并明显高于术前（5.55±1.64）×109/L（P<0.01），其粒细胞（granulocyte, G）（8.82±3.10）×109/L显著高于术前（3.27±1.32）×109/L，增高最为明显，术后单核细胞（monocyte，Mon）计数（0.64±0.38）×109/L高于术前（0.43±0.18）×109/L（P<0.01），而淋巴细胞（lymphocyte, Lym）数量（1.29±0.47）×109/L低于术前（1.73±0.56）×109/L（P<0.01）。术后各类白细胞中β-EP平均荧光强度（MFI）均明显降低（P<0.05），血浆β-EP水平亦显著下降（P<0.01）。结论 围术期全身麻醉患者外周血白细胞数目增加，以粒细胞增高为主，而白细胞中和血浆β-EP水平均降低，细胞数量和β-EP水平的改变与围术期镇痛及机体应激反应有关。
Abstract Objective To investigate the changes of β-endorphin in leukocytes and plasma during scheduled surgery performed under intravenous general anesthesia. Methods forty-eight cases of patients (age ranging from 24 to 65 years old and ASA gradeⅠ-Ⅱ) were anesthesia and blood was collected before and after anesthesia. The peripheral white blood cell(WBC) counts and classification were assessed during perioperative period. Flow cytometry was used to test the expression of β-EP in leukocytes. The plasma concentration of β-endorphin was measured using RIA. Results The WBC after operation were significantly higher than that before operation((10.80±3.39 vs 5.55±1.64)×109/L，P<0.01). According to the differential WBC count, G((8.82±.10 vs 3.27±1.32)×109/L) and Mon((0.64±0.38 vs 0.43±0.18)×109/L) counts were higher after operation, whereas the Lym counts ((1.29±0.47 vs 1.73±0.56)×109/L) were lower(P<0.01). The expression of β-EP in leukocytes and plasma after operation were significantly lower than that before operation. Conclusion The changes of WBC numbers and the level of β-EP are associated with the perioperative endogenous analgesia and stress response.
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