静脉麻醉联合硬膜外麻醉对结肠癌患者围术期细胞免疫的影响

Effects of Intravenous Anesthesia and Epidural Anesthesia on the Perioperative Cellular Immune of Colon Cancer Patients

目的探讨静脉麻醉联合硬膜外麻醉对于结肠癌患者围术期细胞免疫的影响。方法将178例早期结肠癌患者根据随机数字表法分为治疗组与对照组,各89例。采用腹腔镜辅助结肠癌切除手术,对照组给予全身静脉麻醉,治疗组给予静脉麻醉联合硬膜外麻醉。结果治疗组苏醒后即刻疼痛评分为(1.60±0.78)分,而对照组为(2.98±0.89)分,对比差异明显(P<0.05)。2组术毕(T2)与术后3 d(T3)的血清CD4+值都明显低于麻醉诱导前30 min(T1)(P<0.05),不过都明显高于对照组(P<0.05),血清CD8+值在组内与组间对比差异都无统计学意义(P>0.05)。与对照组相比,治疗组术后的肺炎、腹胀、腹泻、腹膜炎等并发症发生情况明显较少(P<0.05),所有并发症经对症处理后好转。结论静脉麻醉联合硬膜外麻醉在结肠癌手术患者中的应用能有效保护细胞免疫功能,发挥更好的镇痛作用,能减少术后免疫损伤,安全性佳,值得推广应用。

Objective To investigate the effects of intravenous anesthesia and epidural anesthesia on the perioperative cellular immune of colon cancer patients. Methods 178 patients with early colorectal cancer,according to the random number table,were equally divided into the treatment group and the control group,all the patients received laparoscopic-assisted surgery,the control group received intravenous anesthesia,the treatment group received intravenous anesthesia combined with epidural anesthesia. Results The postoperative instantly awake pain scores in the treatment group were 1. 60 ± 0. 78 points,while the control group were 2. 98 ± 0. 89 points,there had significantly difference（ P〈 0. 05）. The serum CD4 ＋ values in the 2 groups at postoperative surgery（ T2） and postoperative 3 d（ T3） were significantly lower than before induction of anesthesia 30 min（ T1）（ P〈 0. 05）,but the treatment group were significantly higher than the control group（ P〈 0. 05）,The serum CD8 ＋ values in the 2group had no statistically significant difference（ P 〉0. 05）. The postoperative 3 d pneumonia,abdominal distension,diarrhea,peritonitis and other complications in the treatment group were significantly less than the control group（ P〈 0. 05）,all the complications improved after symptomatic treatment. Conclusion Intravenous anesthesia combined with epidural anesthesia in colon cancer surgery can effectively protect the cellular immune function,plays better analgesic effect,and it can reduce the rate of immune damage,its security is good and it is worthy of application.