麻醉方式对老年肿瘤患者术后血清炎性细胞因子影响的价值研究

The value of different anesthesia methods in the treatment of serum inflammatory cytokines after surgery in elderly patients with cancer

目的探讨不同麻醉方式对老年肿瘤患者术后血清白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及免疫功能学指标的影响。方法回顾性分析笔者在广东省中医药大学第一附属医院2017年9月至2018年2月进修学习时收治的90例老年肿瘤患者的临床资料,其中观察组50例采用腰硬联合麻醉,对照组40例采用全身麻醉。对比2组患者的手术时间、拔管时间和苏醒时间等手术状态,术前、手术15 min及术后血流动力学指标变化,术前和术后3 d免疫功能及血清IL-6、TNF-α变化。结果观察组患者手术时间、拔管时间、苏醒时间均优于对照组,差异有统计学意义(P<0.05)。术前相比,2组患者HR和MAP水平差异无统计学意义(P>0.05),但观察组手术15 min和术后HR及MAP均高于对照组,差异均有统计学意义(P<0.05)。术前相比,2组患者CD^+_3、CD^+_4及CD^+_4/CD^+_8水平差异无统计学意义(P>0.05),且术后3 d观察组CD^+_3、CD^+_4及CD^+_4/CD^+_8均下降明显,且下降幅度低于对照组,差异均有统计学意义(P<0.05)。术前相比,2组患者血清IL-6及TNF-α水平差异无统计学意义(P<0.05),且术后3 d观察组血清IL-6及TNF-α水平均升高,且升高幅度低于对照组,差异均有统计学意义(P<0.05)。结论腰硬联合麻醉可有效改善老年肿瘤患者手术损伤及术后血流动力学,且对患者免疫功能及炎性反应影响较小,值得推广。

Objective To investigate the effects of different anesthesia methods on serum interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) and immunological function indexes in elderly patients with cancer.Methods The clinical data about 90 elderly patients with cancer who were admitted and treated in the First Affiliated Hospital of Guangzhou TCM University from September 2017 to February 2018 were retrospective analyzed. Of them, 50 patients in observation group were treated with combined spinal and epidural anesthesia(CSEA), and 40 patients in control group underwent general anesthesia. The duration of operation time, extubation time and recovery time of the two groups were compared. Changes in hemodynamic parameters before surgery and 15 min after initiation of surgery and after surgery were recorded. In addition, immune function as well as serum IL-6 and TNF-α before surgery and at 3 d after surgery were observed and compared between the two groups.Results The duration of operation, extubation time and recovery time of the observation group were superior to those in control group(P<0.05).Before surgery there were no significant differences in the levels of HR and MAP between the two groups(P>0.05), however, the levels of HR and MAP at 15 min and 3 d after surgery in observation group were significantly highert than those in control group(P<0.05).Before surgery there were no significant differences in the levels of CD+3, CD+4, and CD+4/CD+8 between the two groups(P>0.05),but the levels of CD+3, CD+4 and CD+4/CD+8 at 3 d after surgery in observation group were decreased significantly, moreover,the decrease degree in observation group was more significant than that in control group(P<0.05). Before surgery there were no significant differences in the levels of IL-6 and TNF-α between the two groups(P>0.05),but the levels of IL-6 and TNF-α at 3 d after surgery in observation group were increased significantly, moreover,the increase degree in observation group was lower than that in control group(P<0.05).After surgery,there were no significant differences in serum levels of IL-6 and TNF-α between the two groups(P<0.05). Both serum IL-6 and TNF-α levels were increased in the observation group at 3 d after surgery, but the increase degree was less than that in control group, and the difference was statistically significant(P<0.05).Conclusion CSEA can effectively reduce the surgical injury and improve postoperative hemodynamics in elderly patients with cancer, which has little effect on immune function and inflammatory response of patients. Therefore, it is worthy of promotion.