手术应激与免疫抑制

手术前后时期的心理应激和生理应激均可抑制细胞免疫功能,主要表现为T淋巴细胞和自然杀伤（natural killer,NK）细胞的数量减少和活性减弱。手术创伤越大,对免疫的抑制作用越强,因而对手术后的痊愈有明显影响。一般而言,手术应激所致的免疫抑制可以恢复,恢复的时间主要取决干手术创伤的大小。目前认为,手术引起免疫抑制的机制主要与下丘脑-垂体-肾上腺皮质轴、交感神经系统、细胞因子、阿片肽和T细胞信号分子有关。选用某些不具有免疫抑制作用的止痛药物,以及蛋白酶抑制剂,可以防治手术应激所致的免疫抑制作用。

Surgical stress and immunosuppression

Perioperative psychological and physiological stress can suppress cell-mediated immunity,including the decrease of T lymphocytes and natural killer(NK) cells in the number and activities.A stronger immunosuppression is found in larger postoperative stress than in smaller one,which may interfere with the recovery from the surgical hurt.Generally,the surgical stress-induced immunosuppression can recover,which depends on the degree of surgical injury.The mechanisms through which surgical stress induces the immunosuppression are closely related to hypothalamus-pituitary-adrenocortical axis,sympathetic nervous system,cytokines,opioids and T cell signal molecule.Some strategies may be used to prevent surgical stress-induced immunosuppression,which includes analgesic drugs devoid of immunosuppressive effects and protease inhibitor.