不同麻醉和镇痛方法对食道癌手术患者细胞免疫功能及应激激素水平的影响

Effects of different methods of anesthesia and analgesia on cellular immune function and stress hormone levels in patients undergoing esophageal cancer surgery

目的研究不同麻醉和镇痛方法对食道癌手术患者细胞免疫和应激水平的影响。方法临床纳入该院2014年8月‐2016年8月收治的84例食道癌患者作为研究对象。对照组采用全凭静脉麻醉,进行自控静脉镇痛。观察组采用胸段连续硬脊膜外阻滞麻醉复合静脉麻醉,进行自控硬膜外镇痛。结果观察组T1~T4时刻白细胞介素-8(IL-8)、CD4^+水平高于对照组,血清激素水平低于对照组(P<0.05);T2~T3时刻CD4^+/CD8^+水平高于对照组(P<0.05);T3~T4时刻白细胞介素-2(IL-2)水平高于对照组(P<0.05)。T2~T4时刻皮质醇(Cor)水平、视觉模拟疼痛(VAS)评分低于对照组(P<0.05)。结论食道癌手术患者采用胸段硬膜外阻滞复合静脉麻醉效果较好,对患者细胞免疫功能影响小,应激激素水平较稳定,值得临床应用及推广。

【Objective】To study the effects of different anesthesia and analgesia methods on cellular immunity and stress level in patients with esophageal cancer.【Methods】Eighty-four patients with esophageal cancer who were treated in our hospital from August 2014 to August 2016 were included in this study. The control group was treated with intravenous anesthesia by self-controlled intravenous analgesia. The observation group used thoracic epidural block combined with intravenous anesthesia to control epidural analgesia.【Results】The level of interleukin-8（IL-8）, CD4^＋ was higher, serum hormone level was lower in the observation group at T1-T4 than those in the control group（P 0.05）; at T2-T3, the level of CD4^＋/CD8^＋ in the observation group was higher than that in the control group（P 0.05）; at T3-T4, the level of interleukin-2（IL-2） in the observation group was higher than that in the control group（P 0.05）. The level of cortisol（Cor） and the Visual Analogue Scale（VAS） score in the observation group were lower than those in the control group at T2-T4（P 0.05）.【Conclusion】The effect of thoracic epidural block combined with intravenous anesthesia is better in patients with esophageal cancer operation, the influence on the cellular immune function of the patients is little, stress hormone levels are more stable with better analgesic effect, so it is worthy of clinical application and promotion.