吸入和全凭静脉麻醉对乳腺癌根治术患者免疫水平的影响

Effects of inhalation anesthesia and total intravenous anesthesia on immune level of postoperative breast cancer

目的:研究吸入麻醉和全凭静脉麻醉对乳腺癌根治术患者免疫水平的影响。方法:选择2015-01~2016-01于我院行乳腺癌根治术的女性患者120例为研究对象,根据随机数字表法分为吸入组和全凭组,每组60例。吸入组给予异氟醚吸入维持全麻,全凭组给予异丙酚全凭静脉维持麻醉,观察患者免疫水平(CD3+、CD4+、CD8+、CD4+/CD8+)的变化,比较两组患者麻醉效果和不良反应。结果:与麻醉前相比,吸入组术后1、3d的CD3+、CD4+水平均显著降低,术后1dCD4+/CD8+水平显著降低;全凭组术后1d的CD3+、CD4+和CD4+/CD8+水平显著降低(均P<0.05);两组术后3dCD8+水平均无明显差异(P>0.05)。组间不同时间各指标比较,术后3d全凭组CD3+、CD4+水平显著高于吸入组(P<0.05)。两组患者手术时间、麻醉时间及拔管时间均无明显差异(P>0.05)。吸入组主要不良反应为烦躁、恶心,发生率为33.33%,全凭组主要不良反应为过度镇静,发生率为18.33%。两组不良反应发生率比较,差异有统计学意义(P<0.05)。结论:吸入麻醉和全凭静脉麻醉对行乳腺癌根治术患者的免疫水平均有一定程度的抑制作用,其中全凭静脉麻醉对患者免疫水平的影响较小,且各指标恢复术前水平所需时间较短,不良反应较少。

Objective： To study the effect of inhalation anesyhesia and total intravenous anesthesia on the immune level of patients undergoing radical resection of postoperative breast cancer.Methods： A total of 120 patients with radical mastectomy from January 2015 to 2016 were randomly divided into inhalation group and intravenous group, 60 cases in each group. Inhalation group was given isoflurane inhalation to maintain general anesthesia, intravenous group was given propofol intravenous anesthesia.The changes of immune level （CD3 ＋,CD4＋, CD8＋, CD4 ＋/CD8 ＋） were observed, the anesthesia effect and adverse reaction were compared. Results： Compared with before anesthesia, CD3 ＋ and CD4 ＋ were significantly decreased in the inhalation group 3 days after operation, CD4 ＋/CD8 ＋ was decreased significantly I day after operation,the level of CD3＋ ,CD4＋ and CD4＋/CD8＋ in intravenous group were decreased （P〈0.05）, and there was no significant difference in CD8＋ between the two groups 3 days after operation （P〉0.05）.The indicators of different time in two groups were compared, the levels of CD3 ＋ and CD4 ＋ in the intravenous group were significantly higher than those of in inhalation group （P 〈 0.05）. There was no significant difference in operation time, anesthesia time and extubation time in two groups （P 〉0.05）.The major adverse reactions in inhalation group were irritability and nausea, the total incidence was 33.33%. The major adverse reactions in intravenous group was excessive sedation, the total incidence was 18.33%.The incidence of adverse reactions was significantly different in two groups （P〈 0.05）. Conclusion： Inhalation anesthesia and total intravenous anesthesia have a certain degree of inhibition on the immune level of patients with radical masteetomy. Total intravenousanesthesia has little effect on the immune level for patients,and the time required to restore the preoperative level of each index is shorter with less adverse reactions.