不同麻醉方式对乳腺癌手术病人血清儿茶酚胺及IL-6的影响

The effects of different anaesthesia on serum catechlomine and IL-6 in breast cancer patients

目的: 观察乳腺癌手术时全麻复合硬膜外麻醉(GEA)和单纯全麻(GA)围手术期血清儿茶酚胺和 IL -6的变化,评价其对手术应激反应的影响。方法:将 40 例乳腺癌手术病人随机分为 GEA和 GA两组,于手术前、切皮后30min、120min、术后第1、3日晨采血测定血清儿茶酚胺和 IL- 6 的浓度。结果:两组病人血清去甲肾上腺素(NE)、肾上腺素(E)、多巴胺(DA)、儿茶酚胺总量(CA)切皮后 30min升高,手术120min达高峰,术后第1日清晨依然高于手术前(P<0.05)。手术切皮 30min、120min时,血清儿茶酚胺总量(CA)GA组比GEA组明显偏高(P<0.05)。血清 IL 6 手术 120min时达到高峰,术后第 1日仍高于手术前(P<0.05),但各时点差异无统计学意义(P>0.05)。结论: 乳腺癌手术引起的儿茶酚胺升高,全麻复合硬膜外麻醉对此有一定的抑制作用,但对手术引起的细胞因子水平的改变无影响。

Objective： TO investigate the effects of different anaesthesia on serum catechlomine and IL-6 In surgical breast cancer patients, and evaluate the influence of anaesthesia on surgical stress. Methods： Forty breast cancer patients submitted to elective masteetomy were randomly divided into 2 groups： GEA group （general plus epidural anaesthesia, n = 20）, GA group （genernal anaesthesia,n=20）. Biood samples were taken before operation, 30min, 120min following the incision and at the 1st and 3nd postoperative days. The concentrations of serum catechlomine and IL-6 were detected, Results： The concentrations of serum norepinephrine （NE） ,epinephrine（E）,dopamine（DA） and catechlomine（CA） were similar in 2 groups before operation,and remarkably increased at 30min after incision and reached the peak values at 120min after incision. They were at the high level at the 1st day after oPeration（P〈0.05）. In the GA group, the concentration of CA was remarkable higher than that In the GEA group at the 30min,120min after inoision（P〈0. 05）. （2）The concentration of IL-6 reached the peak level at 120min after incision and it was at the high level the 1st after operation（P〈0.05）. The concentration of IL-6 wasn＇t significantly different at each time point between the two groups. Conclusion ： The general plus epidura anaesthesia can inhibit the elevated serum cateohlomine caused by breast cancer surgery, however can not influence the IL-6. This study suggests that combined anaesthesia can reduce the surgical stress.