不同麻醉方式对直肠癌患者免疫功能的影响

Influence of different anesthesia on immunity of patients with colorectal cancer

目的探讨不同麻醉方式对二氧化碳CO_2气腹腹腔镜下直肠癌手术患者围手术期免疫功能的影响。方法选取2013年1月-2015年12月该院行直肠癌手术的患者94例。比较单纯全身麻醉(GA)、硬脊膜外腔麻醉复合全身麻醉(EA)及EA下6%羟乙基淀粉液急性高容量血液稀释(EA+AHH)麻醉对患者术中一般情况、麻醉情况、围手术期不良反应、随访1个月内并发症发生情况及术前、术中和术后不同时间点患者细胞、体液免疫及血清炎症因子水平变化的影响。结果EA+AHH组术中血压波动、术后苏醒即刻视觉模拟评分(VAS)、不良反应及随访期内感染率低于其他两组;CD3^+、CD4^+、自然杀伤细胞(NK)水平及补体C3、C4水平下降幅度低于其他两组;血清炎症因子水平升高幅度低于其他两组(P<0.05)。结论EA+AHH麻醉方案可改善CO_2气腹腹腔镜下直肠癌手术患者术后细胞和体液免疫状态,降低术后感染风险,值得临床推广应用。

Objective To investigate the influence of different ways of anesthesia on immunity of colorectal cancer patients undergoing CO2 pneumoperitoneum laparoscopy. Methods Totally 288 patients who received colorectal cancer surgery under CO2 pneumoperitoneum laparoscopy in our hospital from January 2013 to December 2015. General anesthesia （GA）, epidural anesthesia （EA） or epidural anesthesia combined with 6% hydroxyethyl starch solution acute hemodilution （EA＋AHH） were performed during surgery. Operation time, blood loss, perioperative adverse events, complications within 1 month post-surgery, cell and humoral immunity and serum levels of inflammatory factors were collected. Results No significant differences in operative time and blood loss were noticed among groups. Blood pressure fluctuation, VAS score, adverse reactions, infection rates and inflammatory factors in （EA ＋ AHH） group were decreased significantly compared with GA or EA. Patients in EA ＋ AHH experienced enhanced levels of CD3＋, CD4＋, NK cell, C3, and C4 when compared with those in GA or EA group. Conclusion EA ＋ AHH significantly improves the cellular and humoral immunity of patients with colorectal cancer undergoing CO2 pneumoperitoneum laparoscopic surgery, reducing postoperative infection rate.