RESUMEN
Objective:To compare the perioperative plasma high-mobility group box 1 protein (HMGB1) concentrations in the patients undergoing laparoscopic radical resection of cervical cancer using different anesthetic regimens.Methods:Sixty-eight American Society of Anesthesiologists physical status Ⅰor Ⅱ patients, aged 34-68 yr, with body mass index of 19-24 kg/m 2, undergoing elective laparoscopic radical resection of cervical cancer, were divided into 2 groups ( n=34 each) using a random number table method: general anesthesia group (G group) and general anesthesia combined with epidural anesthesia group (GE group). In group G, anesthesia was induced with midazolam, etomidate and cisatracurium and maintained with remifentanil, propofol and cisatracurium.In group GE, an epidural catheter was placed at L 1, 2 interspace before induction of anesthesia, general anesthesia was performed after the anesthesia level reached T 6, and the method was similar to those previously described in group G. Patient-controlled intravenous analgesia was used after operation to maintain visual analog scale score ≤ 3 points.Peripheral venous blood samples were collected at 10 min before anesthesia (T 0), at the end of operation, and at 1, 24 and 48 h after operation (T 1-4) for determination of plasma concentrations of HMGB1, interferon-gamma (IFN-γ) and interleukin-4 (IL-4) (by enzyme-linked immunosorbent assay) levels of T lymphocyte subsets CD3 + , CD4 + and CD8 + and CD4 + /CD8 + ratio (by flow cytometry). Results:Compared with group G, the plasma concentrations of IFN-γ and IL-4 were significantly decreased at T 2, 4, the plasma concentration of HMGB1 was decreased at T 2-4, and the levels of CD3 + at T 2-4, CD4 + at T 2 and CD8 + at T 2, 3 and CD4 + /CD8 + ratio were increased in group GE ( P<0.05). Conclusion:The plasma HMGB1 concentration is lower, which has less impact on immune function of the patients undergoing laparoscopic radical resection of cervical cancer with the combination of general anesthesia and epidural anesthesia than that with general anesthesia alone.