全麻复合腰硬联合麻醉对低位直肠癌患者腹腔镜手术后时间及血清免疫球蛋白、C_3水平变化的影响

Effects of general anesthesia combined with combined spinal-epidural anesthesia on the postoperative wake-up time and changes of serum levels of immunoglobulin and C_3 in laparoscopic surgery for patients with low rectal cancer

目的观察全麻复合腰硬联合麻醉对低位直肠癌患者腹腔镜手术后苏醒时间及血清免疫球蛋白、补体3(C_3)水平变化的影响。方法选取择期行腹腔镜手术治疗的低位直肠癌患者78例,按抽签法分为对照组及观察组,每组39例。观察组采取全麻复合腰硬联合麻醉,对照组采取单纯全麻。比较两组麻醉前、麻醉诱导后、气腹建立后、术毕时血流动力学指标[平均动脉压(MAP)、心率(HR)]与麻醉前、气腹建立后、术后24 h、术后72 h血清免疫球蛋白(IgM、IgG)、C_3水平,并对比两组术后呼吸恢复时间、苏醒时间、拔管时间及不良反应发生情况。结果麻醉前两组MAP、HR水平对比,差异无统计学意义(P>0.05),观察组气腹建立后MAP、HR水平低于对照组(P<0.05);麻醉前两组血清IgM、IgG、C_3水平对比,差异无统计学意义(P>0.05),观察组术后24、72 h血清IgM、IgG、C_3水平均高于对照组,且气腹建立后血清C_3水平亦高于对照组(P<0.05);观察组术后呼吸恢复时间、苏醒时间、拔管时间均短于对照组(P<0.05);观察组不良反应发生率(7.69%)与对照组(12.82%)相比,差异无统计学意义(P>0.05)。结论对行腹腔镜手术的低位直肠癌患者采取全麻复合腰硬联合麻醉可显著缩短患者术后呼吸恢复时间、苏醒时间及拔管时间,促进术后麻醉恢复,稳定血流动力学状况,且对免疫功能影响小,安全性高。

Objective To investigate the effect of general anesthesia combined with combined spinal-epidural anesthesia on the postoperative wake-up time and changes of serum levels of immunoglobulin and complement 3(C3) in laparoscopic surgery for patients with low rectal cancer. Methods 78 patients with low rectal cancer treated by laparoscopic surgery were divided into the control group and the observation group according to the drawing method. The participants in observation group received general anesthesia combined with combined spinal-epidural anesthesia, as those in control group received general anesthesia. The hemodynamic indexes, including mean arterial pressure(MAP) and heart rate(HR), before anesthesia, after induction of anesthesia, at the time of establishment of pneumoperitoneum, and after operation were recorded;and serum levels of immunoglobulin(IgM, IgG) and C3 before anesthesia, after pneumoperitoneum establishment, and 24 h and 72 h after operation were compared. The time of recovery of respiration, the time of awakening, the time of extubation and the occurrence of adverse reactions were compared between the two groups.Results There was no significant difference in the levels of MAP and HR between the two groups before anesthesia(P>0.05). The levels of MAP and HR in the observation group were significantly lower than those of the control group after the establishment of the pneumoperitoneum(P<0.05). There was no significant differences in serum level of IgM, IgG or C3 between the two groups before anesthesia(P>0.05). The levels of serum IgM, IgG and C3 24 h and 72 h after operation and after the establishment of the pneumoperitoneum of the observation group were significantly higher than those of the control group(P<0.05). The time of recovery of respiration, the time of awakening and the time of extubation of the observation group were significantly shorter than those of the control group(P<0.05). There was no significant difference in the incidence of adverse reactions between the 2 groups(P>0.05). Conclusion General anesthesia combined with combined spinal-epidural anesthesia in laparoscopic surgery for patients with low rectal cancer can significantly shorten the postoperative time of recovery of respiration, the time of awakening and the time of extubation;promote postoperative anesthesia recovery;and stabilize the hemodynamic state. It has little influence on immune function and is safe.