不同麻醉方法对胃癌手术患者细胞免疫功能影响的Meta分析

Meta analysis on the effects of different anesthesia methods on cellular immune function in patients undergoing gastric cancer surgery

目的系统评价不同麻醉方法对胃癌手术患者免疫功能的影响,为胃癌患者麻醉方法的选择提供依据。方法计算机检索CNKI、万方、维普中文科技期刊全文数据库、Pubmed、Embase、Cochrane Library数据库,检索时间范围为建库到2018-11-30。检索采用主题词加自由词相结合的方法。对符合纳入标准的文献进行质量评估后用RevMan5.3软件进行Meta分析。结果共纳入13项研究,652例患者,其中联合组327例,单纯全身麻醉325例。Meta分析显示,术后24h CD3+水平,术后24h CD4+水平,术后24hCD4+/CD8+水平,术后24hIL-6水平,硬膜外联合全身麻醉相较于全身麻醉对患者免疫功能影响更小,差异具有统计学意义,术后24hNK细胞水平,两组差异无统计学意义。结论连续硬膜外麻醉联合全身麻醉相对于单纯全身麻醉对患者免疫功能影响更小,术后免疫功能恢复更快。

Objective To systematically evaluate the effects of different anesthesia methods on the immune function of patients with gastric cancer so as to provide a basis for the choice of anesthesia methods for gastric cancer patients.Methods The computer retrieved CNKI,Wanfang,Weipu Chinese scientific journal full-text database,Pubmed,Embase,Cochrane Library,and the retrieval time was built in November 2018.The search uses a combination of subject words and free words.Meta-analysis was performed using RevMan5.3 software after quality assessment of the literature that met the inclusion criteria.Results A total of 13 studies were included in 652 patients,including 327 in the combined group and 325 in general anesthesia alone.Meta-analysis showed CD3+levels at 24 hours postoperatively,and CD4+levels at 24 hours postoperatively,CD4+/CD8+level at 24 hours postoperatively,IL-6 level at 24 hours postoperatively,indicating that epidural combined general anesthesia had a statistically significant difference in the immune function of patients compared with general anesthesia.NK cell levels 24 hours after surgery,without significant difference between the two groups.Conclusion Continuous epidural anesthesia combined with general anesthesia has less effect on immune function than alone anesthesia,and postoperative immune function recovery is faster.