全身麻醉联合硬膜外阻滞对宫颈癌根治术患者应激反应及免疫功能的影响

Effects of general anesthesia combined with epidural block on stress response and immune function in patients undergoing radical operation of cervical cancer

目的探讨全身麻醉联合硬膜外阻滞对宫颈癌根治术患者应激反应及免疫功能的影响。方法选择76例宫颈癌根治术患者为研究对象,采用随机数字表法分为观察组和对照组各38例。对照组给予全身麻醉,观察组给予全身麻醉联合硬膜外麻醉。比较两组患者麻醉相关指标、应激反应指标及免疫功能。结果观察组患者丙泊酚、芬太尼、维库溴铵药物用量均明显少于对照组,术毕拔管时间明显短于对照组(P﹤0.01),术后躁动、疼痛发生率均低于对照组(P﹤0.05);切皮时、术后10 min,观察组患者血糖(GLU)、血管紧张素Ⅱ(AngⅡ)、皮质醇(Cor)水平均低于对照组(P﹤0.05);术毕、术后1天、术后3天时,观察组患者CD3+、CD4+、CD4+/CD8+均高于对照组(P﹤0.05)。结论全身麻醉联合硬膜外阻滞麻醉具有全麻用药量少、镇痛充分、苏醒迅速、术后躁动少的优点,可能与缓解宫颈癌根治术患者应激反应、保护免疫功能等因素有关。

Objective To investigate the effects of general anesthesia combined with epidural block on stress response and immune function in patients undergoing radical operation of cervical cancer. Method Seventy-six patients who underwent radical resection of cervical cancer were selected as the subjects and were divided into observation group and control group with 38 cases in each group according to random number table. Patients in the control group were given general anesthesia, and patients the observation group were given general anesthesia combined with epidural block.The anesthesia related indicators, stress reaction and immune function of the two groups were compared. Result The dosage of propofol, fentanyl and vecuronium for patients in the observation group was significantly less than that for patients in the control group, the extubation time of patients in the observation group was significantly shorter than that of patients in the control group（P〈0.01）, the incidences of postoperative restlessness and pain in patients of the observation group were significantly lower than those in patients of the control group（P〈0.05）; at the time of the skin was cut and 10 min later, the blood glucose（GLU）, Angiotensin Ⅱ（Ang Ⅱ） and cortisol（Cor） of patients in the observation group was significantly lower than those in patients of the control group（P〈0.05）. At 1 d and 3 d after operation, the CD3^＋, CD4^＋and CD4^＋/CD8^＋in the observation group were significantly higher than those in the control group（P〈0.05）. Conclusion General anesthesia combined with epidural anesthesia has the advantages of less drug use, sufficient analgesia, rapid awakening and less agitation after operation. It may be related to the relief of stress response and protection of immune function in patients with radical operation of cervical cancer.