不同麻醉方法对开胸食管癌根治术患者血流动力学及术后免疫功能的影响

Effects of different anesthesia methods on hemodynamics and postoperative immune function in patients undergoing radical operation of thoracic esophageal carcinoma

目的观察丙泊酚闭环麻醉、丙泊酚闭环麻醉+胸椎旁神经阻滞、丙泊酚闭环麻醉+连续硬膜外麻醉对开胸食管癌根治术患者血流动力学及免疫功能的影响。方法选择食管癌切除术患者119例为研究对象,随机分为三组:全麻组(G组),胸椎旁阻滞+全麻组(P+G组),硬膜外阻滞+全麻组(E+G组)。记录心率(HR)、平均动脉压(MAP)及脑电双频指数(BIS)、苏醒期及术后视觉模拟评分(VAS)、镇静-躁动评分(SAS)、恶心呕吐等不良反应情况。检测T细胞亚群(CD3^+,CD4^+,CD8^+,CD4^+/CD8^+)比值。结果与G组相比,G+E组在T_3、T_4、T_5、T_6、T_7、T_8、T_9的MAP明显降低,在T_4、T_6、T_7、T_8、T_9的HR降低,拔管后VAS值较低,术后SAS升高且伴恶心呕吐。P+G组在T_3、T_4、T_9时MAP和HR均明显降低,苏醒后VAS评分显著降低且无恶心呕吐。与P+G组相比,E+G组在T_5、T_6、T_7、T_9时MAP明显降低,在T_3、T_6、T_8和T_9时HR降低,且伴有恶心呕吐。与G组相比,P+G组和E+G组的CD3^+细胞和CD4^+细胞比例在T_(12)时显著增加。结论椎旁神经阻滞复合全麻可有效维持血流动力学稳定,减少术后不良反应发生,有助于改善术后细胞免疫功能。

Objective To observe the effects of different methods on hemodynamics and immune function in patients undergoing thoracic esophageal cancer resection between the closed-loop propofol total intravenous anesthesia,the closed-loop propofol anesthesia with paravertebral blocks,and the closed-loop propofol anesthesia with continuous epidural anesthesia.Methods One hundred and nineteen patients undergoing left open thoracic esophagectomy were selected.They were randomly divided into three groups,including general anesthesia group(G group),thoracic paravertebral block with general anesthesia group(P+G group),and epidural anesthesia with general anesthesia group(E+G group).The heart rate(HR),mean arterial pressure(MAP),and bispectral index(BIS)were recorded at different time.Postoperative visual analogue scale(VAS)and calm-agitation score(SAS),and adverse reaction was recorded.T cell subsets,for example,CD3+,CD4+,CD8+,CD4+/CD8+,were measured.Results Compared with G group,the MAP were decreased significantly in E+G group at T3,T4,T5,T6,T7,T8,and T9.The HR were decreased in E+G group than those in G group at T4,T6,T7,T8,T9.The VAS was decreased in E+G group than those in G group.Compared with G group,the SAS were increased in E+G group with PONV.Compared with G group,the MAP and the HR were significantly reduced in P+G group at T3,T4,and T9.The VAS score were significantly reduced in P+G group compared with G group without PONV.Compared with P+G group,the MAP was significantly low in E+G group at T5,T6,T7 and T9.The HR was reduced in E+G group at T3,T6,T8 and T9 with PONV.Compared with the G group,the cells ratios of CD3+and CD4+were significantly increased in the P+G group and E+G group at T12.Conclusion The method of P+G can maintain the stability of hemodynamics in patients undergoing radical operation of esophageal cancer and reduce the adverse reaction.It may improve the postoperative cellular immunity of patients.