腰硬联合麻醉与硬膜外麻醉对子宫切除术患者免疫细胞及激素水平的影响

Effects of spinal-epidural anesthesia and epidural anesthesia on the levels of immune cells and hormones in patients after hysterectomy

目的：比较腰硬联合麻醉与硬膜外麻醉对子宫切除术患者免疫细胞及激素水平的影响。方法：将2012年6月~2013年6月择期行腹腔镜子宫切除术的112例患者随机分为观察组和对照组,每组56例,观察组和对照组患者分别接受腰硬联合麻醉与硬膜外麻醉后均在腹腔镜下接受全子宫切除术。两组患者分别于麻醉前（T0）、手术结束时（T1）、术后12 h（T2）、术后24 h（T3）和术后48 h（T4）检测辅助性T细胞（TH1、TH2）以及皮质醇、去甲肾上腺素、肾上腺素的水平。结果：1两组患者麻醉时间、手术时间及ASA分级差异无统计学意义（P〉0.05）;2观察组患者T1、T2、T3和T4时Th1细胞亚群和Th1/Th2显著高于对照组（P〈0.01）,而Th2细胞亚群显著低于对照组（P〈0.01）;3观察组患者T1、T2、T3和T4时皮质醇、去甲肾上腺素、肾上腺素水平显著低于对照组（P〈0.01）。结论：腰硬联合麻醉较硬膜外麻醉对子宫切除术患者的免疫细胞及激素水平影响较小,利于患者术后恢复。

Objective： To compare the effects of spinal - epidural anesthesia and epidural anesthesia on the levels of immune cells and hormones in patients after hysterectomy. Methods： A total of 112 patients who received hysterectomy under laparoscope from June 2012 to June 2013 were randomly divided into observation group and control group, 56 patients in each group. The patients in observation group were treated with spinal - epidural anesthesia, and the patients in control group were treated with epidural anesthesia. The levels of helper T -cells （TH1 and TH2） and hormones （cortisol, norepinephrine and adrenaline） were detected before anesthesia （T0 ）, at the end of operation （T1 ）, at 12 hour after operation （T2 ）, at 24 hour after operation （T3 ） and at 48 hour after operation （T4 ） . Results： There was no statistically significant difference in anesthesia time and operation time and grading of ASA between the two groups （P 〉 0. 05 ） ; the levels of Thl and Th1/Th2 in observation group at T1, T2, T3 and T4 were statistically significantly higher than those in control group （P 〈0. 01 ）, but the levels of Th2 in observation group at T1 ,T2, T3 and T4 were statistically significantly lower than those in control group （P 〈 0. 01 ） ; the levels of cortisol, norepinephrine and adrenaline at T1, T2, T3 and T4 were statistically significantly lower than those in control group （P 〈 0. 01 ） . Conclusion： Compared with epidural anesthesia, spinal -epidural anesthesia has less impact on the levels of immune cells and hormones in patients after hysterectomy, and it is beneficial to recovery after operation.