腹腔镜胆囊切除术患者行全身麻醉复合硬膜外麻醉对血栓素A2、血浆内皮素和免疫功能的影响研究

Clinical impact on plasma endothelin, thromboxane A2, and immune function of laparoscopic cholecystectomy in patients under general anesthesia combined with epidural anesthesia

目的探讨腹腔镜胆囊切除术(LC)患者行全身麻醉复合硬膜外麻醉对血栓素A2(TXA2)、血浆内皮素(ET)和免疫功能的影响作用。方法选取该院2013年1月-2015年1月行LC患者90例,根据入院的先后顺序随机分为单一组和复合组,每组45例,前者采用单一全身麻醉,后者采用全身麻醉复合硬膜外麻醉。观察比较两组患者的血流动力学指标、TXA2、ET及免疫功能等。结果复合组患者血流动力学各项指标,诸如舒张压(DBP)、收缩压(SBP)、平均动脉压(MAP)、心率(HR)等,较单一组患者更为稳定,组间比较差异具有统计学意义(P<0.05或P<0.01)。单一组和复合组患者T_1时TXA_2及ET均较T0时降低,随后T_2~T_4时两组TXA2及ET逐渐升高,且单一组TXA2各时间点升高幅度及T_4时ET升高幅度均明显多于复合组,组间比较差异具有统计学意义(均P<0.01)。T5时单一组CD3^+、CD4^+、CD8^+水平均较T_0时均明显降低(P<0.05或P<0.01),而复合组CD4^+无明显变化(P>0.05),且T_7时单一组患者CD3^+、CD4^+水平明显低于复合组,组间比较差异具有统计学意义(均P<0.01)。T_5和T_7时复合组患者CD4^+/CD8^+明显高于单一组患者,组间比较差异具有统计学意义(均P<0.01)。结论与单纯全身麻醉比较,全身麻醉复合硬膜外麻醉有助于降低行LC患者的应激反应,诸如对患者的循环、呼吸、血浆TXA2、ET以及免疫功能的影响较小,减少了手术风险因素的发生,加快了患者术后的康复速度,是一种安全、有效的麻醉用药方案。

Objective To investigate the clinical impact on plasma endothelin, thromboxane A2, and immune function by laparoscopic cholecystectomy（LC） in patients under general anesthesia combined with epidural anesthesia. Methods According to the order of admission, 90 cases of patients who received laparoscopic cholecystectomy in our hospital from 2013 January to 2015 January were randomly divided into single group and compound group, 45 patients in each group. Patients in single group received general anesthesia, while patients in compound group were received general anesthesia combined with epidural anesthesia. Then compare two groups of patients with hemodynamic index, thromboxane A2（TXA2）, plasma endothelin（ET）, as well as immune function. Results Patients of compound group were more stable with hemodynamic indicators, such as the DBP and SBP, MAP, HR, than those in the single group, the differences between groups with statistical significance（P〈0.05 or P〈0.01）. T_1TXA2 and ET was reduced of T_0 in patients of both single and compound group, then time of T_2~T_4TXA2 and ET increased in both groups, and TXA2 of every time and ET of time T——4 raised more marked in single group than compound group, the differences between groups with statistical significance（each P〈0.01）. CD3~＋, CD4~＋, CD8~＋level of time T_0 were significantly lower compared with of time T_5 in single group（P〈0.05 or P〈0.01）, while the CD4~＋of compound group had no obvious change（P〈0.05）, and single group had a lower level of CD3~＋, CD4~＋on time of T_7 than those in compound group, the differences between groups with statistical significance（each P〈0.01）. Patients of compound group had obviously higher CD4~＋/CD8~＋value than those in a single group on time of T_5 and T_7, and the differences between two groups with statistical significance（each P〈0.01）. Conclusions Compared with general anesthesia, patients who receive laparoscopic cholecystectomy under general anesthesia combined with epidural anesthesia has less stress reaction, such as the patient＇s circulation, respiration, plasma TXA2, ET and little effect on the immune function,which can reduce the operation risk factors and accelerate the recovery of the patients with postoperative as a safe and effective anesthetic regimen.