硬膜外复合全麻对结肠癌腔镜围术期患者的免疫抑制作用观察

Observation on the immunosuppressive effects of epidural combined anesthesia in perioperative patients undergoing laparoscopic surgery for colon cancer

目的观察硬膜外复合全麻对结肠癌腔镜围术期患者的免疫抑制作用。方法选取2013年11月至2014年6月我院收治的结肠癌患者102例为研究对象,随机分为观察组和对照组各51例,其中对照组术前进行单纯全身麻醉,观察组在全身麻醉诱导前行硬膜外麻醉,记录手术时间、麻醉剂维持时间、麻醉苏醒时间、麻醉苏醒时视觉模拟评分(VAS),采集两组麻醉前30min(T0)、切皮后2 h(T1)、术毕(T2)、术后3 d(T3)4个时间点静脉血,分析T淋巴细胞亚群CD3^+、CD4^+、CD8^+、CD4^+/CD8^+及NK细胞活性,并应用Elisa法分析两组血清白细胞介素-6(IL-6)、C反应蛋白(CRP)水平变化。结果观察组手术时间(54.32±2.89)min、麻醉剂维持时间(10.05±0.01)min、麻醉苏醒时间(3.01±0.79)min、苏醒时VAS评分(2.61±0.75)分与对照组比较显著较低(P<0.05);与T0时比较,两组CD3+、CD4^+、CD4^+/CD8^+、NK细胞活性均有所下降,其中对照组上述指标在T1-T3时与较观察组下降明显(P<0.05);观察组CD4^+、CD4^+/CD8^+在T2、T3时显著下降(P<0.05),观察组CD3^+、NK细胞下降显著发生在T3时(P<0.05);CD8+在各时间点及组间比较无显著差异(P>0.05);麻醉后,观察组CRP(22.43±3.14)mg/L水平显著低于对照组,观察组IL-6(99.38±3.89)pg/ml明显高于对照组(P<0.05)。结论腹腔镜结肠癌根治术对患者围术期细胞免疫有一定抑制作用,采取硬膜外复合全麻可减降低对细胞免疫及炎症因子的影响,有利于保护患者免疫功能。

Objective To observe the immunosuppressive effects of epidural combined anesthesia in perioperative patients undergoing endoscopic surgery for colon cancer. Methods 102 patients with colon cancer who were treated in our hospital between November 2013 and June 2014 were selected as the study objects. According to the random number table method, the patients were divided into the observation group and the control group, 51 cases in each group. The control group were given simple general anesthesia before surgery. The observation group were given epidural anesthesia before general anesthesia. The operation time, anesthetic duration, anesthesia recovery time and visual analogue scale（VAS） at anesthesia recovery were recorded. The venous blood samples were collected at 30 mins before anesthesia（T0）, 2h after skin incision（T1）, at the end of surgery（T2） and 3 days after surgery（T3）. The activity of T lymphocyte subsets, including CD3^＋, CD4^＋, CD8^＋, CD4^＋/CD8^＋ and NK were analyzed. The changes of levels of serum interleukin-6（IL-6） and C reactive protein（CRP） in the two groups were analyzed by Elisa method. Results The operation time（54.32±2.89） min, anesthetic duration（10.05±0.01） min,anesthesia recovery time（3.01 ±0.79） min and VAS score at anesthesia recovery（1.61 ±0.98） of the observation group were significantly lower than those of the control group（P 0.05）; Compared with T0, the cell activities of CD3＋, CD4^＋, CD4^＋/CD8^＋ and NK in the two groups decreased, and the decline of those indexes in the control group was more obvious than that in the observation group at T1-T3（P〈0.05）; At T2 and T3, CD4^＋ and CD4^＋/CD8^＋ in the observation group decreased significantly（P〈0.05）. CD3＋ and NK in the observation group decreased significantly at T3（P〈0.05）; There was no significant difference in CD8^＋ between groups at different time points（P〈0.05）; After anesthesia, CRP（22.43±3.14） mg/L level in the observation group was significantly lower than that in the control group while IL-6（99.38±3.89） pg/ml was significantly higher than that in the control group（P〈0.05）.Conclusion Laparoscopic radical surgery for perioperative patients with colon cancer has certain immunosuppressive effects. To adopt epidural combined general anesthesia can reduce the reduce the effects on cellular immune and inflammatory factors. It is conducive to protecting patient＇s immune function.