局部黏膜麻醉联合非气管插管全身麻醉对EMR术中血清学指标的影响

Influence of Local mucosal anesthesia combined non tracheal intubation general anesthesia on EMR patients' serological indexes

目的:分析局部黏膜麻醉联合非气管插管全身麻醉对内镜下黏膜切除术(endoscopic mucosal resection,EMR)术中血清学指标的影响。方法:选择于2013年9月至2014年9月间在本院接受EMR治疗的患者162例作为研究对象,按照随机数表法将所有入组患者分为观察组(81例,接受局部黏膜麻醉联合非气管插管全身麻醉)、对照组(81例,接受局部黏膜麻醉联合常规气管插管全身麻醉),比较两组患者炎症指标、应激指标、免疫指标等方面的差异。结果:(1)观察组患者接受全身麻醉后血清中白介素-23(IL-23)、白介素-32(IL-32)、降钙素原(PCT)、β-内啡肽(β-EP)、肿瘤坏死因子-α(TNF-α)等因子水平均明显低于对照组患者(P<0.05);(2)观察组患者接受全身麻醉后血清中皮质醇(COR)、血管内皮素(ET)、甲状腺激素(TH)、胰岛素(Ins)等因子水平均明显低于对照组患者(P<0.05);(3)观察组患者接受全身麻醉后血清中可溶性细胞间黏附分子1(sICAM-1)、CD11b、CD18、CD20水平低于对照组患者,CD56水平高于对照组患者(P<0.05)。结论:局部黏膜麻醉联合非气管插管全身麻醉在为EMR术患者提供足够的麻醉深度的同时,可以有效降低术中全身炎症反应及应激反应,有助于对机体免疫功能的保护。

Objective： To analyze Influence of Local mucosal anesthesia combined non tracheal intubation general anes- thesia on EMR patients＇ serological indexes. Methods：Choosed 162 cases of patients received EMR between September 2013 to September 2014 in our hospital as research object,according to stochastic indicator method divided into observation group（81 cases） treated with Local mucosal anesthesia combined non tracheal intubation general anesthesia,control group（81 cases） re- ceived local mucosal anesthesia combined routine tracheal intubation general anesthesia, compared inflammation index, stress in- dex,immune index. Results; 1）observation group patients serum IL-23, IL-32, PCT,13-EP and TNF-~ factor levels were signifi- cantly lower than control group patients（P〈0.05）;2）observation group patients serum COR and ET, TH, Ins levels were significantly lower than control group patients（P〈0.05） ; 3） observation group patients serum sICAM 1, CD1 lb, CD18, CD20 levels were lower than control group patients, CD56 level was higher than control group patients（P〈0.05）. Conclusion Local mucosal anesthesia combined non tracheal intubation general anesthesia for EMR provide adequate anesthesia depth at same time,can effectively reduce the intraoperative systemic inflammatory response and stress response, contribute to the protection of the body＇s immune function.