不同麻醉方式对腹部手术患者术后感染与免疫功能及血清IL-6和TNF-α水平的影响研究

Effects of different anesthetic methods on infections,immune function and serum IL-6 and TNF-αafter abdominal surgery

目的探讨不同麻醉方式对腹部外科手术患者术后感染与免疫功能及血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平的影响。方法 2015年10月-2016年10月选取150例腹部外科手术患者,分为吸入麻醉组50例(A组),全凭静脉麻醉组50例(B组),硬膜外阻滞复合全麻组50例(C组),比较各组患者麻醉效果、术后感染、免疫功能及血清IL-6、TNF-α水平。结果 C组患者术后感染率低于A组、B组,差异有统计学意义(P<0.05),而苏醒及拔管时间短于A组、B组,差异有统计学意义(P<0.05),A组、B组术后感染率、苏醒及拔管时间比较,差异无统计学意义;3组术后6h、1dCD3+、CD4+、CD4+/CD8+水平较术前低,而术后3d恢复至术前水平(P<0.05),而C组术后6h、1dCD3+、CD4+、CD4+/CD8+水平高于A组、B组,而A组、B组术后6h、1d、3d CD3+、CD4+、CD4+/CD8+水平比较差异无统计学意义;C组患者术后6h、1d、血清IL-6、TNF-α水平低于A组、B组,差异有统计学意义(P<0.05),而A组、B组术后6h、1d血清IL-6、TNF-α水平比较差异无统计学意义。结论硬膜外阻滞复合全麻有利于外科手术患者早期拔管,减轻患者免疫抑制,降低患者术后血清炎症因子水平,有助于降低术后感染。

OBJECTIVE To investigate the effects of different anesthesia methods on infgctions, immune function and the levels of serum interleukin-6 （IL-6） and tumor necrosis factor-α（TNF-α）in patients with abdominal surgery. METHODS A total of 150 cases of patients with abdominal surgery were enrolled from Oct. 2015 to Oct. 2016. The patients were divided into inhalation anesthesia group （group A, n= 50）, total intravenous anesthesia group （group B, n=50）, and epidural anesthesia combined with general anesthesia （group C, n= 50）. The anesthesia effect, postoperative infection, immune function and the levels of serum IL-6 and TNF-A were compared among each group. RESULTS The postoperative infection rate in group C was lower than that in group A and group B （P 〈0.05）, while the recovery time and extubation time were shorter than those in group A and B, and the postoperative infection rate recovery time and extubation time had no significant difference between group A and group B. The levels of CD3 ＋ ,CD4 ＋, and CD4 ＋/CD8 ＋ in 3 groups at 6 h and 1 d after operation were significantly lower than those before operation, and were restored to preoperative levels at 3 d after operation（P〈0.05）. The levels of CD3＋ ,CD4＋ , and CD4＋/CD8＋ in group C were higher than those in group A and group B at 6 h and 1 d after operation, while those in group A and B had no significant difference. The levels of serum IL-6 and TNF-α in group C were lower than those in group A and group B at 6 h and 1 d after operation （P〈0.05）, but there was no significant difference between group A and group B. CONCLUSION Epidural anesthesia combined with general anesthesia is beneficial to early extubation in patients with surgery, it can relieve immunosuppression and decrease the postoperative levels of serum inflammatory factors in patients, which may help to reduce postoperative infection.