不同麻醉方式对子宫恶性肿瘤根治术患者的免疫功能及CA125表达的影响

Effects of different anesthesia methods on immune function and CA125 expression in patients undergoing radical hysterectomy

目的探讨全凭静脉麻醉与全麻联合硬膜外麻醉对子宫恶性肿瘤根治术患者术后免疫功能及血清CA125水平的影响。方法选取本院2018年7月至2019年6月收治的行子宫恶性肿瘤根治术患者80例,随机分为全凭静脉组(全麻组)和全麻联合硬膜外麻醉组(联合麻醉组),各40例。比较两组麻醉前5 min(T0)、术后即刻(T1)、术后24 h(T2)、术后48 h(T3)及术后72 h(T4)免疫指标(CD4^+、CD8^+、IgG、IgA)及血清CA125水平变化。结果T0时刻,两组CD4^+、CD8^+、IgG、IgA、CA125比较差异无统计学意义;T1~T3时刻,两组CD4^+、CD8^+均出现明显下降(P<0.05),均在T2时刻下降到最低值后开始上升,并在T4时刻恢复到T0时刻水平,但联合麻醉组在T1~T3时刻CD4^+、CD8^+均高于全麻组(P<0.05);T1~T4时刻,两组CA125均明显下降(P<0.05),联合麻醉组CA125均低于全麻组(P<0.05);两组T1~T4各时刻IgG、IgA均无明显变化。结论全凭静脉麻醉和全麻联合硬膜外麻醉均为有效麻醉方法,相较于静脉全身麻醉,联合麻醉对子宫恶性肿瘤根治术患者术后免疫抑制效果更小,对血清CA125表达水平的改善效果更优。

Objective To investigate the effect of general anesthesia and general anesthesia combined epidural anesthesia on immune function and serum CA125 level in patients with radical hysterectomy.Methods From July 2018 to June 2019,80 cases of radical hysterectomy were selected.According to different anesthesia strategies,they were random divided into general anesthesia group and combined anesthesia group,with 40 cases in each group.The changes of immune indexes(CD4^+,CD8^+,IgG,IGA)and serum CA125 were compared between the two groups at 5 min before anesthesia(T0),immediately after operation(T1),24 h after operation(T2),48 h after operation(T3)and 72 h after operation(T4).Results At T0,there was no significant difference in CD4^+,CD8^+,IgG,IgA and CA125 between the two groups;at T1-T3,there was a significant decrease in CD4^+,CD8^+in both groups(P<0.05),which began to rise after the lowest value at T2,and recovered to T0 at T4,but CD4^+,CD8^+in the combined anesthesia group were higher than those in the general anesthesia group at T1-T3(P<0.05);at T1-T4 CA125 in the combined anesthesia group was lower than that in the general anesthesia group(P<0.05),and there was no significant change in IgG and IgA between T1 and T4 in both groups.Conclusion Intravenous general anesthesia and general combined epidural anesthesia are two effective anesthesia methods.Compared with intravenous general anesthesia,general combined epidural anesthesia has less immunosuppressive effect on patients with radical hysterectomy,and better effect on the improvement of serum CA125 expression.