阿片类药物麻醉可以调节受损的免疫反应，而少阿片类药物麻醉可以保留免疫功能。本研究旨在评估无阿片类药物麻醉 (OFA) 和阿片类药物麻醉 (OA) 对局部晚期 GC (LAGC) 患者围手术期巨噬细胞分化、细胞因子变化和围手术期并发症的影响。我们使用恢复质量- 15 (QoR-15) 问卷评分和视觉模拟量表 (VAS) 评分来比较术后恢复质量和疼痛水平。此外，比较两组患者的不良反应情况。检测围术期血清炎性细胞因子水平及巨噬细胞亚型比例。OFA组拔管时间和PACU停留时间明显延长,而OA组低血压发生率、去甲肾上腺素剂量较高、PONV和头晕发生率较高,并延迟肠胃气排出时间。 OFA组术后24 h QoR-15评分显着高于OA组。手术结束或手术后，OFA组白细胞介素（IL）-12、IL-1β、肿瘤坏死因子（TNF）-α、CD68 CD163-巨噬细胞率水平较高，但IL-10水平较低，转化生长因子 (TGF)-β 和 CD68 CD163 巨噬细胞率，表明 OFA 通过减少 M2 和促进 M1 巨噬细胞极化来减弱围术期免疫抑制。并且在新辅助PD-1抑制剂的LAGC患者中这种逆转趋势更为明显。OFA可能通过减少M2和促进M1巨噬细胞极化来减轻新辅助PD-1抑制剂LAGC患者围手术期的免疫抑制。http://gcpgl.sysucc.org .cn，标识符 2022-FXY-001。版权所有 © 2024 刘、欧、薛、杨、叶、王、谢。

Opioid anesthesia can modulate the impaired immune response and opioid-sparing anesthesia may preserve immune functions. This study was performed to assess the effects of opioid-free anesthesia (OFA) and opioid-based anesthesia (OA) on perioperative macrophages differentiation, cytokine changes, and perioperative complications in locally advanced GC (LAGC) patients.We used quality of recovery-15 (QoR-15) questionnaire scores and visual analog scale (VAS) scores to compare postoperative quality of recovery and pain level. In addition, the adverse reactions of patients in the two groups were compared. The perioperative serum level of inflammatory cytokines and the ratio of macrophage subtypes were detected.The OFA group had significantly longer extubation time and PACU stay, whereas the OA group had significantly higher rate of hypotension, higher doses of norepinephrine, higher PONV and dizziness rate, and delayed flatus passage time. The QoR-15 score on postoperative 24 h was significantly higher in OFA group than in OA group. At the end of or after the surgery, the OFA group had higher levels of interleukin (IL)-12, IL-1β, tumor necrosis factor (TNF)-α, CD68+CD163- macrophage rate, but lower levels of IL-10, transforming growth factor (TGF)-β, and CD68+CD163+ macrophage rate, indicating OFA attenuated perioperative immunosuppression by diminishing M2 and promoting M1 macrophage polarization. And the reversal tendency is more obvious in LAGC patients with neoadjuvant PD-1 inhibitor.The OFA may attenuate perioperative immunosuppression by diminishing M2 and promoting M1 macrophage polarization in LAGC patients with neoadjuvant PD-1 inhibitor.http://gcpgl.sysucc.org.cn, identifier 2022-FXY-001.Copyright © 2024 Liu, Ou, Xue, Yang, Ye, Wang and Xie.