硬膜外阻滞联合全身麻醉对老年肺癌根治术患者认知功能及细胞免疫功能的影响

Effect of epidural block combined with general anesthesia on cognitive function and cellular immune function in elderly patients following radical lung cancer surgery

目的探讨硬膜外阻滞联合全身麻醉对老年肺癌根治术患者认知功能及细胞免疫功能的影响。方法采用查随机数字表法将40例老年肺癌根治术患者随机分为观察组和对照组,每组20例。观察组采用硬膜外阻滞联合全身麻醉,对照组采用静脉全身麻醉。用酶联免疫吸附试验(ELISA)双抗体夹心法测定CD3^+、CD4^+、CD8^+、CD4^+/CD8^+细胞和NK细胞水平,简易智力状态检查表(MMES)评估认知功能,VAS评分法及Ramsay镇静评分法评估疼痛和镇静状况,并观察两组患者手术时间、术后恢复自主呼吸时间、苏醒时间以及拔管时间。结果观察组患者手术时间、术后恢复自主呼吸时间、苏醒时间以及拔管时间均优于对照组(P<0.05),但两组患者术后6 h、12 h VAS疼痛评分和Ramsay镇静评分差异均无统计学意义(P>0.05)。两组患者术后1 d CD3^+、CD4^+、CD4^+/CD8^+、NK细胞水平均低于术前(P<0.05);CD8^+细胞水平高于术前(P<0.05);观察组患者术后1 d和7 d CD3^+、CD4^+、CD4^+/CD8^+、NK细胞水平均显著高于对照组(P<0.05),但CD8^+细胞水平与对照组比较差异无统计学意义(P>0.05)。术后7 d两组患者CD3^+、CD4^+、CD4^+/CD8^+、NK细胞水平明显高于术后1 d(P<0.05),CD8^+细胞水平明显低于术后1 d(P<0.05);观察组术后7 d CD3^+、CD4^+、CD4^+/CD8^+、NK细胞水平明显高于对照组(P<0.05),CD8^+细胞水平明显低于对照组(P<0.05)。两组患者MMES评分均显著低于术前(P<0.05),但观察组评分高于对照组;术后认知功能障碍发生率亦低于对照组(P<0.05)。结论硬膜外阻滞联合全身麻醉对老年肺癌根治术后认知功能影响较小,同时可促进细胞免疫功能恢复。

Objective To analyze the effects of epidural block combined with general anesthesia on cognitive function and cellular immune function in elderly patients after radical lung cancer operation. Methods Patients treated at our hospital were randomly assigned to be trealed with intravenous anesthesia （n=20） or the combination of epidural block and general anesthesia （n=20）. Levels of T cell subsets and NK cells were determined using double antibody-sandwich enzyme-linked immunosorbent assay （ELISA）. The simple mental s ＂tate examination （MMES） was used to assess cognitive function in both groups. Pain and sedation were assessed using the VAS score and Ramsay sedation score. Postoperative time to spontaneous breathing, eye opening and cxtubation were also recorded. Results The combination therapy group showed significantly shorter operating time than the intravenous anesthesia group, as well as significantly shorter time to spontaneous breathing,eye opening,and extubation（P〈0.05 ）. The two treatment groups showed similar VAS pain scores and Ramsay sedation scores at 6 and 12 h postoperatively （P〉0.05）. Compared to preoperative day 1 ,levels of CD3＋,CD4＋,and NK cells as well as the CD4＋/CD8~ ratio were lower on postoperative day 1 （P〈O.05）, while the level of CDS＋cells was higher on postoperative day 1 （P〈0.05）. Levels of CD3＋,CD4＊,and NK cells as well as the CD4＋/CD8＋ ratio on postoperative day 1 and postoperative day 7 were significantly higher in the combination therapy group than in the intravenous anesthesia group （P〈0.05）,while the level of CDS＊ cells was no significant difference. In two treatment groups,levels of CD3＋,CIM＊,and NK cells cells as well as the CD4＋/CD8＋ ratio were significantly higher on postoperative day 7 than on postoperative day 1, while the level of CD8＋ cells was significantly lower. On postoperative day 7,levels of CD3＊, CD4＋,and NK cells as well as the CD4＊/CD8＋ ratio were significantly higher in the combination therapy group than in the intravenous anesthesia group ,while the level of CD8＋ calls was significantly lower（ P〈O.05 ）. Both treatment groups scored signifieantly lower on cognitive function on postoperative than on preoperative （P〈0.05）, while the combination therapy group scored significantly higher than the intravenous anesthesia group（ P〈0.05 ）. Conclusion Epidural block combined with general anesthesia is associated with significantly better cognitive function and recovery of cellular immune function in elderly patients following radical lung cancer surgery.