硬膜外麻醉联合全身麻醉对乳腺癌根治术患者炎性因子、免疫功能的影响

Effects of epidural anesthesia combined with general anesthesia on inflammatory factors and immune function in patients with radical mastectomy for breast cancer

目的探讨硬膜外麻醉联合全身麻醉对乳腺癌根治术患者炎性因子、免疫功能的影响。方法依据麻醉方式的不同将98例乳腺癌根治术患者分为对照组(n=47)和观察组(n=51),对照组患者给予单纯全身麻醉,观察组患者给予硬膜外麻醉联合全身麻醉。比较两组患者的手术相关指标、炎性因子[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、免疫功能指标[中性粒细胞计数、淋巴细胞计数,计算中性粒细胞与淋巴细胞比值(NLR)]、皮质醇水平和术后并发症发生情况。结果观察组术后拔管时间、苏醒时间及住院时间均明显短于对照组(P﹤0.01)。术后24 h,两组患者hs-CRP、IL-6、TNF-α、皮质醇水平均高于本组术前(P﹤0.05),但观察组患者hs-CRP、IL-6、TNF-α、皮质醇水平均低于对照组(P﹤0.05)。术后24 h,两组患者中性粒细胞计数、NLR均高于本组术前(P﹤0.05),淋巴细胞计数均低于本组术前(P﹤0.05),但观察组患者中性粒细胞计数、NLR均低于对照组(P﹤0.05),淋巴细胞计数高于对照组(P﹤0.05)。观察组术后并发症总发生率为11.76%,低于对照组患者的29.79%(P﹤0.05)。结论硬膜外麻醉联合全身麻醉可有效缓解乳腺癌根治术患者的炎性反应、应激反应,减轻免疫功能抑制作用,降低并发症发生率,有利于患者的术后恢复。

Objective To investigate the effect of epidural anesthesia combined with general anesthesia on inflamma-tory factors and immune function in patients with radical mastectomy for breast cancer.Method A total of 98 patients with radical mastectomy for breast cancer were divided into control group(n=47)and observation group(n=51)accord-ing to different anesthesia methods.The control group was given simple general anesthesia group,and the observation group was given epidural anesthesia combined with general anesthesia.The operation-related indicators,inflammatory factors[high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)],and immune function indexes[neutrophil count,lymphocyte count,neutrophil-to-lymphocyte ratio(NLR)],cortisol levels,and postop-erative complications were compared between the two groups.Result The postoperative extubation time,recovery time and hospitalization time of the observation group were significantly shorter than those of the control group(P<0.01).At 24 h after the operation,the levels of hs-CRP,IL-6,TNF-α,and cortisol in the two groups were higher than those before the operation(P<0.05),however,the levels of hs-CRP,IL-6,TNF-α,and cortisol were lower than those in the control group(P<0.05).At the same time,the neutrophil count and NLR in the two groups were higher than those before the oper-ation(P<0.05),and the lymphocyte count was lower than that before the operation in the same group(P<0.05),however,the neutrophil count and NLR in the observation group were lower than those in the control group(P<0.05),and the lym-phocyte count was higher than that in the control group(P<0.05).The total incidence of postoperative complications in the observation group was 11.76%,which was lower than 29.79%in the control group(P<0.05).Conclusion Epidural anesthesia combined with general anesthesia can effectively relieve the inflammatory response and stress response in pa-tients with radical mastectomy for breast cancer,reduce the immunosuppressive effect,and reduce the incidence of complications,which is beneficial to the postoperative recovery of patients.