不同麻醉方法对食管癌手术患者免疫及认知功能的影响

Effects of Different Anesthesia Methods on Immunity Function and Cognitive Dysfunction in Patients Undergoing Esophageal Cancer

目的:探讨全麻或全麻复合硬膜外麻醉对食管癌手术患者的T细胞水平及术后认知功能的影响。方法:选择2014年1月至2015年12月于我院择期行开胸手术的食管癌患者100例为研究对象,根据手术时间顺序分为观察组(全麻复合硬膜外麻醉)和对照组(全麻),每组50例,观察记录两组患者诱导前、插管时、术中1 h、拔管后的平均动脉压(MAP)、血氧饱和度(Sp O2)和心率(HR);两组患者术前30 min、术后2 h、术后2 d和术后7 d的T细胞亚群水平,包括CD3^+、CD4^+、CD8^+、CD4^+/CD8^+;两组患者术前1 d,术后6 h,术后1 d,术后3 d的认知功能;术后认知功能障碍(POCD)发生率。结果:诱导前观察组和对照组患者的MAP、Sp O2和HR比较,差异均不显著(P>0.05),插管时、术中1h和拔管后观察组患者的MAP和HR水平均明显低于对照组(P<0.05),而Sp O2明显高于对照组(P<0.05)。术后2 h,观察组和对照组的CD3^+、CD4^+、CD8^+、CD4^+/CD8^+值均较术前30 min明显降低(P<0.05),但两组间各指标值无显著性差异(P<0.05);术后2 d,观察组的CD3^+、CD4^+、CD8^+、CD4^+/CD8^+值均明显高于对照组(P>0.05)。术后7 d,两组的T细胞亚群水平均较术前30 min无显著性差异(P>0.05)。术后6 h和术后1 d,两组的MMSE评分均较术前1 d明显下降(P<0.05),观察组术后1 d、3 d和7 d的MMSE评分均明显高于对照组(P<0.05)。术后6 h,观察组的POCD发生率明显低于对照组(P<0.05),术后1 d和3 d观察组的POCD发生率低于对照组,但无统计学差异(P>0.05)。结论:与单凭全麻比较,全麻复合硬膜外麻醉对食管癌手术患者的T细胞水平及术后认知功能的影响较小,术后恢复快。

Objective： To compare the effects of general anesthesia combined with epidural anesthesia and general anesthesia on t-cell immunity function and postoperative cognitive dysfunction in patients undergoing esophageal cancerl Methods： 100 cases of patients undergoing esophageal cancer in our hospital from January 2014 to December 2015 were divided into observation group（n=50, general anesthesia combined with epidural anesthesia） and control group （n=50, general anesthesia）. The MAP, SpO2, HR and the levels of CD3＋, CD4＋, CD8＋ and CD4＋/CD8＋ in two groups were compared. Results： There was no significant differences in the mean arterial pressure（MAP）, SpO2 and heart rate（HR） before the induction between two groups（P〉0.05 ）; During intubation, intraoperative 1 h and after extubation, MAP and HR of patients in the observation group was significantly lower than that of the control group （P〈0.05）, and SpO2 was significantly higher than that of the control group （P〈0.05）; after 2 hours of operation, the levels of CD3^＋, CD4^＋, CD8^＋, CD4^＋ /CD8^＋ of two groups were significantly lower than that of 30 min of preoperation （P〈0.05）, but there was no significant differences between two groups （P〉0.05）; After 2 d of operation, the levels of CD3^＋, CD4^＋, CD8^＋, CD4^＋/CD8^＋ of the observation group was signifi- cantly higher than that of the control group （P〈0.05）; After 7 d of operation, the levels of CD3^＋, CD4^＋, CD8^＋, CD4^＋/CD8^＋ of two groups were back to normal. After 6 h and I d of operation, MMSE scores of two groups were significantly lower than that of 1 day ofpreoperation （P〈0.05）, MMSE scores of the observation group was significantly higher than that of the control group after 1,3,7 d of operation （P〈0.05）; after 6 h of operation, POCD incidence rate of the observation group was significantly lower than that of the control group（P〈 0.05）. Conclusions： Compared with general anesthesia, general anesthesia combined with epidural anesthesia can effectively reduce the influence to t-cell immunity function and postoperative cognitive dysfunction in patients undergoing esophageal cancer.