不同麻醉方法对妇科手术患者免疫功能的影响

Effects of different anesthesia methods on immune function in patients with gynecological surgery

目的观察并分析不同麻醉方法对妇科手术患者免疫功能的影响。方法选取2014年1月~2015年12月在十堰市妇幼保健院进行妇科手术的患者156例为研究对象,根据麻醉方式将所有患者分为三组,A组采用右美托咪定静脉泵注联合七氟烷吸入麻醉,B组采用七氟烷吸入麻醉,C组采用丙泊酚联合舒芬太尼麻醉。观察所有患者麻醉开始前(T_0)、术后2 h(T_1)、术后6 h(T_2)、术后12 h(T_3)、术后1 d(T_4)、术后3 d(T_5)、术后7 d(T_6)时的收缩压(SBP)、舒张压(DBP)、心率(HR)、呼吸率(RR)和血氧饱和度(Sp O2)外周血T_淋巴细胞亚群数量变化情况及炎症细胞因子变化。结果 A组患者T_1、T_2、T_3时的SBP,T_1、T_2时的DBP、RR,T_1、T_6的T_NF-α水平,T_1~T_6的IL-6、IL-8水平,T_1时的CD3^+水平,T_1、T_2时的CD4^+水平与T_0时比较,差异有统计学意义(P<0.05)。B组患者T_1、T_2、T_3时的SBP,T_1、T_2时的RR,T_1、T_2、T_5、T_6时的T_NF-α水平,T_1~T_6的IL-6、IL-8水平,T_1时的CD3^+水平,T_1、T_2、T_3时的CD4^+水平与T_0时比较,差异有统计学意义(P<0.05)。C组患者T_1、T_2、T_3时的SBP,T_1、T_4~T_6的T_NF-α水平,T_6时的IL-1β水平,T_1~T_6的IL-6、IL-8水平,T_1时的CD3^+、CD4^+水平与T_0时比较,差异有统计学意义(P<0.05)。B组患者T_1~T_6的IL-6水平,T_1、T_5、T_6的IL-8水平,C组患者T_5时的T_NF-α水平,术后T_1~T_6的IL-6、IL-8水平与A组同时期比较,差异有统计学意义(P<0.05)。C组患者术后T_1~T_6的IL-6、IL-8水平与B组同时期比较,差异有统计学意义(P<0.05)。结论右美托咪定静脉泵注联合七氟烷吸入对妇科手术患者产生免疫功能抑制作用较小,与其他麻醉方法相比较患者术后免疫功能恢复更快,是临床上妇科患者手术麻醉的理想方法,值得在临床上进行推广应用。

Objective To observe and analyze the effects of different anesthesia methods on immune function in pa- tients with gynecological surgery. Methods From February 2014 to December 2015, in Shiyan Maternal and Child Health-Care Hospital, 156 patients underwent gynecological surgery were selected, they were divided into three groups by the anesthesia method, group A was given Dexmedetomidine intravenous infusion combined with Sevoflurane inhala- tion anesthesia, group B was given Sevoflurane inhalation anesthesia, group C was given Propofol combined with Sufen- tanil anesthesia. The changes of SBP, DBP, HR, RR, SpO2, peripheral blood T lymphocyte subsets and inflammatory cytokines of all patients were observed at before anesthesia （T0）, after surgrey 2 h （T1）,after surgrey 6 h （T2）, after sur- grey 12 h （T3）, after surgrey 1d （T4）, after surgrey 3 d （T5）, after surgrey 7 h （T6）. Results The levels of SBP at T1, T2, T3, DBP, RR at T1, T=, TNF-α at T1, T6, IL-6, IL-8 at T1-T6, CD3^＋ at Tl, CD4^＋ at Tl, T2 of group A were compared with those at T0, the differences were statistically significant （P 〈 0.05）. The levels of SBP at T1, T2, T3, RR at T1, T2, TNF-α at T1, T2, T5, T6, IL-6, IL-8 at T1-T6, CD3^＋ at T1, CD4^＋ at T1, T2, T3 of group B were compared with those at To, the dif- ferences were statistically significant （P 〈 0.05）. The levels of SBP at T1, T2, T3, TNF-α at T1, T4-T6, IL-1β at T6, IL-6, IL-8 at T1-T6, CD3^＋, CD4^＋ at T1 of group C were compared with those at To, the differences were statistically significant （P 〈 0.05）. The levels of IL-6 at T1-T6, IL-8 at T1, T5, T6 of group B, the levels of TNF-α at T5, IL-6,IL-8 at T1- T6 of group C were compared with those at the same time points of group A, the differences were statistically sig- nificant （P 〈 0.05）. The levels of IL-6, IL-8 at T1-T6 of group C were compared with those at the same time points of group B, the differences were statistically significant （P 〈 0.05）. Conclusion The combination of Dexmedeto- midine and Sevoflurane inhalation has a transient inhibitory effect on the immune function of gynecological patients. Compared with other anesthesia methods, the immune function recovered more quickly after surgery, which is anesthesi- a for gynecological patients ideal method, it is worth to popularize and apply in clinic.