硬膜外麻醉与全身麻醉及麻醉深度对子宫颈癌患者围术期免疫功能、应激反应的影响

Effects of epidural anesthesia,general anesthesia and depth of anesthesia on the immune function and stress response of patients with cervical cancer during perioperative period

目的探讨分析硬膜外麻醉与全身麻醉及麻醉深度对子宫颈癌患者围术期免疫功能、应激反应的影响。方法选取2015年1月至2019年2月大连大学附属中山医院诊治的286例子宫颈癌患者作为研究对象。按照随机数字表法将其分为A组(n=145)和B组(n=141),A组采取硬膜外麻醉,B组采取全身麻醉。根据术中脑电意识深度检测系统Narcotrend指数判断麻醉深度,将Narcotrend指数46~20作为深麻醉,将Narcotrend指数70~55作为浅麻醉,A组深麻醉亚组78例、浅麻醉亚组67例,B组深麻醉亚组71例、浅麻醉亚组70例。比较组患者手术时间及术中出血量,记录患者麻醉前、术后即刻、术后1d、术后3d两组患者T淋巴细胞亚群、NK细胞百分比以及血糖(Glu)、皮质醇(Cor)、C反应蛋白(CRP)水平变化。结果不同麻醉方式、麻醉深度患者术中出血量及手术时间差异均无统计学意义(P>0.05)。术后即刻、术后1d、术后3d各组患者CD3^+T细胞、CD4^+T细胞、CD4^+/CD8^+以及NK细胞百分比均较术前降低,差异具有统计学意义(P<0.05),其中B组患者降低程度较A组更明显,差异具有统计学意义(P<0.05),组内比较浅麻醉患者各指标降低程度较深麻醉患者更明显,差异具有统计学意义(P<0.05)。术后即刻、术后1d、术后3d各组患者Glu、Cor以及CRP比均较术前升高,其中B组患者升高程度较A组更为明显,差异具有统计学意义(P<0.05),组内比较浅麻醉患者各指标升高程度较深麻醉患者更明显,差异具有统计学意义(P<0.05)。结论与全身麻醉相比较,硬膜外麻醉可有效降低子宫颈癌患者围术期免疫抑制、减轻机体应激反应,同时深麻醉对患者免疫功能影响较小且应激反应较轻,麻醉医师应综合考虑患者状况,选择合适的麻醉方式及麻醉深度。

Objective To investigate the effects of epidural anesthesia,general anesthesia and depth of anesthesia on the immune function and stress response of patients with cervical cancer during perioperative period.Methods 286 patients with cervical cancer who underwent surgery in our hospital from January 2016 to February 2019 were divided into group A(145 cases)and group B(141 cases)according to random number table method.Group A received epidural anesthesia and group B received general anesthesia.The depth of anesthesia was judged by Narcotrend index of intraoperative electroencephalo-graph(EEG)depth of consciousness detection system.Narcotrend index 46~20 was used as deep anesthesia,and Narcotrend index 70~55 was used as shallow anesthesia.There were 78 cases as deep anesthesia subgroup,67 as shallow anesthesia subgroup in group A.There were 71 cases as deep anesthesia subgroup,70 as shallow anesthesia subgroup in group B.The operation time and bleeding volume were compared.The changes in T lymphocyte subsets,NK cell percentage,Glucose(Glu),cortisol(Cor)and C reactive protein(CRP)levels were recorded before,immediately after and 1,3 days after anesthesia.Results There was no significant difference in blood volume and operation time between different anesthesia methods and depth of anesthesia(P>0.05).The percentages of CD3^+,CD4^+,CD4^+/CD8^+and NK cells were significantly lower in all groups immediately after operation,a day after operation and 3 days after operation(P<0.05),especially in group B(P<0.05).Glu,Cor and CRP were significantly higher in all groups immediately after operation,a day after operation and 3 days after operation(P<0.05),especially in group B(P<0.05).The indexes of shallow anesthesia patients were significantly higher than those of deep anesthesia patients(P<0.05).Conclusions Compared with general anesthesia,epidural anesthesia can effectively reduce the immune suppression and stress response of patients with cervical cancer during perioperative period,while deep anesthesia has less impact on the immune function and stress response.Therefore,patient's overall condition should be considered to choose appropriate anesthesia methods and depth.