不同麻醉方法对腹腔镜结肠癌手术患者T淋巴细胞亚群和白细胞介素的影响

Effects of different anesthetic methods on T lymphocyte subsets and interleukin in patients undergoing laparoscopic colon cancer surgery

目的研究不同麻醉方法对腹腔镜结肠癌手术患者T淋巴细胞亚群和白细胞介素的影响。方法选取2016年5月至2017年4月在我院行腹腔镜结肠癌手术治疗的患者84例,随机分为观察组和对照组,各42例。对照组采取单纯全身麻醉,观察组采取硬膜外复合全麻。比较两组患者手术和麻醉情况,同时比较两组患者手术前、后T淋巴细胞亚群和白细胞介素-6(IL-6)水平。结果两组患者的术中失血量、手术时间、胶体液输注量、晶体液输注量比较,差异无统计学意义(P>0.05);观察组患者的七氟醚吸入平均浓度、术后苏醒即刻VAS评分显著低于对照组(P<0.05)。术后1 d,两组患者CD3+、CD4+、CD4+/CD8+水平均明显降低,IL-6水平均明显上升,且观察组上述指标均优于对照组(P<0.05);两组患者不同时间段CD8+水平无明显变化,组间对比差异无统计学意义(P>0.05)。结论腹腔镜结肠癌手术患者选取硬膜外复合全麻方式,相对于单纯全麻方式可以减少患者七氟醚吸入浓度,降低患者苏醒即刻疼痛程度,对患者围术期T淋巴细胞亚群及IL-6所带来的影响较小。

Objective To study the effect of different anesthetic methods on T lymphocyte subsets and interleukin inpatients undergoing laparoscopic colon cancer surgery. Methods From May 2016 to April 2017, 84 patients withlaparoscopic colon cancer surgery in our hospital were selected and randomly divided into observation group and controlgroup, with 42 cases in each group. The control group took simple general anesthesia, and the observation group tookepidural general anesthesia. The operation and anesthesia of the two groups were compared. At the same time, the levelsof T lymphocyte subsets and interleukin-6 （IL-6） before and after operation were compared between the two groups.Results There were no significant differences in intraoperative blood loss, time of operation, infusion of colloidal fluidsand infusion of crystal fluids between the two groups （P〉0.05）; the sevoflurane inhalation average concentration and theVAS score at waking up in the observation group were significantly lower than those in the control group （P〈0.05）. After1 day of operation, the levels of CD3＋, CD4＋, CD4＋/CD8＋in the two groups significantly decreased, and the levels of IL-6significantly increased, and the above indicators in the observation group were significantly better than those in thecontrol group （P〈0.05）. There were no significant differences in CD8＋levels between the two groups at different timepoints（P〉0.05）. Conclusion The selection of epidural combined general anesthesia in patients with laparoscopic coloncancer surgery can reduce the concentration of sevoflurane inhalation and reduce the degree of immediate pain in patientsthan the selection of simple general anesthesia, and has less influence on the T lymphocyte subgroup and IL-6 in theperioperative period.