Effect of epidural block combined intravenous general anesthesia stress on the stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy

Objective: To investigate the effect of epidural block combined with intravenous anesthesia on stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy. Methods: In our hospital from July 2016 to June 2017 undergoing radical mastectomy for breast cancer of 88 patients were randomly divided into observation group and control group of 44 cases, 2 patients underwent routine preoperative preparation, and routine blood pressure, heart rate, pulse, oxygen saturation, ECG monitoring, control group with intravenous anesthesia. The observation group was treated with epidural block combined with intravenous anesthesia. 2 groups of patients before anesthesia, 30 MIM (T0), 1 h after skin incision (T1), 4 h after operation (T2), 24 h after operation (T3), 48 h after operation (T4) from peripheral venous blood were measured by interleukin-8 (IL-8) and interferon gamma (IFN-γ), cortisol (Cor), prolactin (PRL), growth hormone (GH) and T lymphocyte subsets (CD3+, CD4+, CD8+), the calculation of CD4+/CD8+ value. Results: the serum IL-8 level of T1, T2, T3and T4 decreased gradually, were lower than at T0, and the control group at each time point had no significant difference, T1, T2, T3group, T4IL-8 levels lower than the control group;the 2 groups of serum IFN-γ levels T1 and T2had no significant change, T3and T4increased gradually, was higher than that of T0, but no significant difference between the 2 groups of IFN-γ levels. 2 serum Cor levels peaked at T1, decreased at T2, was higher than that of T0, T3, T4returned to T0, the observation group T1, T2Cor level lower than the control group;the serum PRL levels of 2 groups reached a peak at T1, T2, T3at the time of T4decreased gradually, was higher than that of T0, T1, T2, T3of the observation group at the PRL level is lower than the control group;the serum level of GH 2 in group T1increased gradually, reached a peak at T2, T3and T4 decreased gradually, was higher than that of T0, the observation group T1, T2, T3, T4, GH levels lower than the control group. 2 groups of CD3+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD3+ was higher than the control group;group CD4+ decreased gradually in T1, T2, T3and T4were lower than control, T0when, and the observation group CD4+ in T1, T2, T3, T4, no significant changes were observed in group T1, T2, T3, T4and CD4+ higher than that of the control group;the 2 group CD8+ had no obvious changes in T1, T2, T3, T4;observation group CD4+/CD8+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD4+/CD8+ was higher than the control group. Conclusion: epidural block combined with intravenous anesthesia for breast cancer radical mastectomy can effectively relieve the stress and inflammatory reaction, alleviate the immunosuppression, and help to restore the postoperative immune function.

Effects of Total Intravenous Anesthesia and Static Aspiration Combined General Anesthesia on Postoperative Cognitive Function and Psychological State of Elderly Patients with Esophageal Cancer

Objective: To compare the effects of total intravenous anesthesia and static aspiration combined general anesthesia on postoperative cognitive function and psychological state of elderly esophageal cancer patients. Methods: From July 2020 to April 2021, 180 elderly patients who underwent radical esophageal cancer surgery in our hospital were randomly divided into 90 cases in the control group and 90 in the observation group. The control group used static aspiration compound general anesthesia, and the patients in the observation group used intravenous anesthesia to compare the cognitive function and psychological state of the two groups of patients. Results: There was no statistical difference in the cognitive function score of patients in the observation group 30 minutes before anesthesia, 1 h and 24 hours after anesthesia compared with that in the control group, P > 0.05;there was no statistical difference between the Hamilton Anxiety Scale (HAMA) scores 30 minutes before and 24 hours after anesthesia in the observation group compared with the control group, P > 0.05;the cognitive function score of patients in the observation group of 4 h after surgery and 12 h after operation was significantly higher than that of the control group;the HAMA scores of patients in the observation group of 1 h, 4 h and 12 h after surgery were significantly lower than that of the control group, P Conclusion: The application of total intravenous anesthesia in elderly patients with esophageal cancer surgery can reduce the impact of anesthesia on their cognitive function and psychological state, which is worth popularizing and applying in clinical practice.

Effect of ultrasound-guided pleural paravertebral block combined with general anesthesia on serum monocyte chemokinin-1, interleukin-6 and interleukin-10 levels in patients with early breast cancer after modified radical mastectomy

Objective: To investigate the effect of ultrasound-guided pleural paravertebral block combined with general anesthesia on serum monocyte chemokinin-1 (McP-1), interleukin-6 (il-1) and il-10 levels in patients with early breast cancer after modified radical mastectomy. Methods: A total of 76 patients with early breast cancer from October 2015 to July 2018 were selected from our hospital and divided into study group (n=38) and control group (n=38). The control group received general anesthesia, and the study group received ultrasound-guided paravertebral block combined with general anesthesia. Data of two groups of perioperative situation (PCIA press the number, volume of intraoperative sufentanil and PACU time), preoperative and postoperative 12 h, 24 h serum factor (MCP-1, IL-6, IL-10) level, after 2 h, 4 h, 8 h, 12 h, 24 h when pain (VAS) score, preoperative (T1), 15 min after the anesthesia (T2), 5 min after surgery (T3) hemodynamic state [heart rate (HR), mean arterial pressure (MAP)], the incidence of adverse reactions were counted. Results: (1) Perioperative status: PCIA presses, intraoperative dose of sufentanil and PACU duration in the study group were less than those in the control group. (2) Serum factors: there was no significant difference in serum McP-1, il-6 and il-10 levels between the two groups before operation. The serum levels of McP-1, il-6 and il-10 in the two groups 12 h after operation were higher than those before operation. The serum levels of McP-1, il-6 and il-10 in the two groups at 24 h after surgery were significantly lower than those at 12 h after surgery, and the serum levels of McP-1, il-6 and il-10 in the group at 12 h and 24 h after surgery were lower than those of the control group. (3) Pain degree: the VAS score of the study group at 2 h, 4 h, 8 h, 12 h and 24 h after surgery was lower than that of the control group. (4) Hemodynamics: there was no significant difference in HR and MAP between the two groups during T1, HR and MAP in T2 were lower than those in T1, but the level of each indicator in the study group was higher than that in the control group. (5) Adverse Reactions: the incidence of adverse reactions was lower in the study group (10.53%) than in the control group (28.95%). Conclusion: The application of ultrasound guided early breast cancer modified radical block complex general anesthesia thoracic vertebra, can reduce the dosage of anesthetic drugs, shorten the PACU, residence time, reduce postoperative pain, maintain stable hemodynamic state, inhibiting inflammatory reaction caused by surgical trauma degree, and can reduce the incidence of adverse reactions, and has safety.

Postoperative Analgesia and Cesarean Section under General Anesthesia: Multicenter Study

Background: Neuraxial anesthesia with intrathecal morphine is the reference technique in cesarean section anesthesia for the management of postoperative analgesia. If there is a contraindication to this, general anesthesia is required. The objective of the study was to evaluate the analgesic effectiveness of 4 analgesic techniques performed during cesarean section under general anesthesia in two centers with different anesthetic practices (North Franche Comté Hospital and Omar Bongo Ondimba Army Training Hospital). Method: This is a retrospective and descriptive study over 2 years, from January 1, 2019 to December 31, 2020. It involved evaluating the analgesic effectiveness and tolerance of morphine in the epidural catheter, wound infiltration, intravenous analgesia and Transversus Abdominous Plane block (TAP block) from the post-anesthesia care unit (PACU) until the 4th post-operative day. Results: Of the 354 cesarean sections performed, 84 (11.14%) received general anesthesia. The average age was 32.27 years. Acute fetal distress was the first indication for cesarean section (45.2%), followed by hemorrhagic placenta previa (10.7%) and prolapse of the cord (8.33%). Morphine in the epidural catheter was the most used (47.6%) followed by parietal infiltration (36.9%), intravenous analgesia (13.1%) and TAP block (2.38%). The analgesic effectiveness was comparable between the techniques from postoperative day 0 to day 4. No difference in side effects. Postoperative morphine consumption was significantly reduced (p = 0.011) in the infiltration (9 mg) and TAP block (9mg) groups compared to the epidural catheter (16 mg) and intravenous analgesia (17 mg). No difference in 02 rehabilitation criteria (ambulation, first bowel movement). No difference in the occurrence of chronic pain. Conclusion: In the event of a cesarean section under general anesthesia, there are effective and well-tolerated alternatives to neuraxial anesthesia, particularly regional anesthesia techniques (nerve blocks), particularly in countries with low availability of morphine.

高龄患者腹腔镜肠癌手术的不同麻醉方法研究

目的 研究不同麻醉方法在高龄患者腹腔镜肠癌手术中的应用价值。方法 58例在本院行腹腔镜手术的高龄肠癌患者,用随机数字表法将其分为观察组和对照组,每组29例。对照组行全身麻醉(全麻),观察组行全麻复合硬膜外阻滞麻醉。比较两组患者麻醉优良率、呼吸恢复时间、睁眼时间、拔管时间、躁动发生情况以及气腹前、气腹时和气腹后的平均动脉压(MAP)、心率。结果 观察组的麻醉优良率96.55%高于对照组的79.31%,差异显著(P<0.05)。气腹前,两组患者MAP比较无明显差异(P>0.05);气腹时和气腹后,观察组MAP分别为(84.63±2.05)、(85.05±2.14)mm Hg(1 mm Hg=0.133 kPa)均低于对照组的(87.62±2.18)、(88.79±2.66)mm Hg,差异显著(P<0.05),且观察组血压更稳定。气腹前,两组患者心率比较,无明显差异(P>0.05);气腹时和气腹后,观察组患者心率分别为(83.53±2.05)、(78.07±2.11)次/min,均低于对照组的(90.12±2.17)、(85.46±2.48)次/min,差异显著(P<0.05),且观察组患者术中心率更为稳定。观察组患者的呼吸恢复时间(4.25±0.78)min、睁眼时间(8.87±1.45)min、拔管时间(14.66±1.38)min与对照组的(9.96±1.32)、(12.54±1.05)、(20.28±2.46)min相比较短,差异显著(P<0.05)。观察组的躁动发生率3.45%与对照组的20.69%相比较低,差异显著(P<0.05)。结论 将全麻复合硬膜外阻滞麻醉运用在高龄腹腔镜肠癌患者的手术中可获得较好的麻醉效果,既有利于患者术中血流动力学的稳定,又可以缩短患者术后清醒时间,降低躁动发生风险,优势突出,故具备临床借鉴与推广的价值。

ERAS模式下硬膜外阻滞和腹横肌平面阻滞在老年患者行腹腔镜前列腺癌根治术中的应用比较

目的比较加速康复外科(ERAS)模式下硬膜外阻滞与超声引导下腹横肌平面阻滞对老年患者行腹腔镜前列腺癌根治术的围术期镇痛效果及术后功能恢复情况。方法选择2023年2月—2023年10月于复旦大学附属肿瘤医院择期行腹腔镜前列腺癌根治手术的老年患者120例,使用随机数字表法分为全麻复合硬膜外阻滞组(EA组)和全麻复合腹横肌平面阻滞组(TAP组),每组60例。采用视觉模拟评分(VAS)评估并比较2组患者术后的疼痛程度;观察并比较2组患者围术期舒芬太尼用量、患者胃肠道功能恢复时间(第一次肛门排气和排便的时间、第一次饮水及第一次进食半流质的时间)、患者首次下床活动时间、拔除导尿管时间、住院时间、不良反应和手术并发症发生率。结果因4例患者被剔除研究,最终116例患者被纳入统计。2组患者在术后各个时间点的静息和运动状态下的VAS评分差异均无统计学意义(P>0.05)。2组患者围术期舒芬太尼用量差异无统计学意义(P>0.05)。TAP组患者排气时间、排便时间、进食时间、下地活动时间均明显少于EA组(P<0.05);2组拔尿管时间、住院时间差异无统计学意义(P>0.05)。EA组和TAP组术后不良反应发生率差异无统计学意义(8.62%vs 6.90%,P>0.05);EA组和TAP组手术并发症发生率差异无统计学意义(5.17%vs 3.45%,P>0.05)。结论腹横肌平面阻滞对腹腔镜前列腺癌根治术的老年患者可能提供等同硬膜外麻醉的良好镇痛效果,能促进老年患者胃肠道功能恢复,有利于患者早期下床活动,更加符合ERAS理念。

星状神经节阻滞对胃癌手术患者术后胃肠功能恢复及炎症应激反应的影响

目的探究星状神经节阻滞对胃癌手术患者术后胃肠功能恢复及炎症应激反应的影响。方法前瞻性纳入2020年1月至2022年1月在南阳市肿瘤医院拟接受腹腔镜下胃癌根治术治疗的103例胃癌患者作为研究对象,采用信封法分为对照组(n=51)和研究组(n=52)。对照组患者行全麻复合硬膜外麻醉(CEGA),研究组患者行星状神经节阻滞联合CEGA麻醉。比较两组患者麻醉前后不同时间点的血流动力学变化、视觉模拟评分(VAS)以及手术前后不同时间的炎症因子和应激反应水平,同时比较两组患者的胃肠功能恢复情况和术后并发症发生情况。结果入室时两组患者的收缩压、舒张压及心率比较差异均无统计学意义(P>0.05);与入室时比较,两组患者插管后、切皮后、手术开始1 h时的收缩压、舒张压及心率均降低,且研究组的收缩压、舒张压和心率明显低于对照组,差异均有统计学意义(P<0.05)。术后2 h、24 h、48 h时,两组患者的VAS评分比较差异均无统计学意义(P>0.05)。两组患者术前的超敏C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素8(IL-8)、白细胞介素6(IL-6)水平比较差异均无统计学意义(P>0.05);与术前比较,两组患者术后的上述各指标水平均降低,且研究组术后的CRP、TNF-α、IL-8、IL-6水平明显低于对照组,差异均有统计学意义(P<0.05)。切皮1 h时,两组患者的超氧化物歧化酶(SOD)、皮质醇(Cortisol)、血清丙二醇(PG)水平比较差异均无统计学意义(P>0.05);与切皮1 h时相比较,术毕两组患者的SOD、Cortisol、PG水平均升高,且研究组术毕的上述各指标明显低于对照组,差异均有统计学意义(P<0.05)。术后研究组患者的进食时间、排气时间及肠鸣音恢复时间分别为(33.12±5.79)h、(30.56±4.49)h、(23.64±6.11)h,明显短于对照组的(53.16±6.78)h、(52.11±6.12)h、(31.08±5.97)h,差异均有统计学意义(P<0.05)。术后两组患者的恶心、呕吐、头晕、下肢麻木、瘙痒、低血压发生率比较差异均无统计学意义(P>0.05)。结论星状神经节阻滞对腹腔镜下胃癌根治术患者具有较好的麻醉效果,其可有效降低炎症应激反应,加速胃肠功能的恢复,并且不会明显增加并发症发生率。

规范化硬膜外阻滞复合全麻对老年卵巢癌细胞减灭术患者的影响

目的:探讨规范化硬膜外阻滞复合全麻对老年卵巢癌细胞减灭术应激、免疫指标的影响。方法:选取2022年6月至2023年9月兰州市第一人民医院收治的80例老年卵巢癌患者,分为对照组和观察组,各40例,对照组在手术时实施全麻,观察组进行规范化硬膜外阻滞复合全麻,比较两组麻醉后患者的应激、免疫指标变化情况。结果:观察组术后并发症明显低于对照组(P<0.05);两组诱导前、术毕时HR、MAP水平差异无统计学意义(P>0.05),气管插管、切皮后、手术探查时,观察组明显低于对照组(P<0.05);术后当天、第5天两组炎症因子水平无明显差异(P>0.05),术后1天、术后3天观察组炎症因子水平明显高于对照组(P<0.05)。结论:对于进行细胞减灭术的老年卵巢癌患者实施规范化硬膜外阻滞复合全麻的麻醉方式,患者术后并发症发生率相对较低,围手术期间血流动力学保持平稳,并且能减轻患者术后免疫功能的抑制。

硬膜外阻滞复合全身麻醉对结直肠癌根治术患者术后恢复的影响

目的观察硬膜外阻滞复合全身麻醉对结直肠癌根治术术后恢复的影响。方法选取2021年8月—2024年3月期间接受结直肠癌根治术的64例患者,依据麻醉方式的不同分为联合麻醉组(简称联合组)和对照组,每组各32例。对照组患者采用普通全身麻醉完成手术,联合组使用全身麻醉联合椎管内麻醉完成手术,比较两组患者术后并发症发生率和首次排气时间、排便时间和住院天数。结果联合组的术后并发症发生率显著低于对照组(P<0.05),其术后首次排气时间、排便时间和住院天数均显著短于对照组(P<0.05),术后12 h的视觉模拟评分法(VAS)评分显著低于对照组(P<0.05)。结论硬膜外复合全身麻醉可显著降低结直肠癌根治术的术后并发症发生率,促进患者术后排气、排便,缩短住院时间。

七氟烷和丙泊酚全麻复合硬膜外阻滞麻醉对宫颈癌患者术后的影响

目的:探究七氟烷和丙泊酚全麻复合硬膜外阻滞麻醉对宫颈癌患者术后的影响。方法:选取2022年3月—2023年3月菏泽市中医医院收治的宫颈癌患者70例为研究对象,依据随机排列表法分为研究组和对照组,各35例。对照组应用七氟烷和丙泊酚全麻,研究组在对照组基础上应用硬膜外阻滞麻醉。比较两组患者苏醒情况、免疫指标、麻醉质量、麻醉不良反应。结果:研究组自主呼吸恢复时间、清醒时间、胃肠恢复时间短于对照组,差异有统计学意义(P=0.001);术后12、24 h,两组患者CD3^(+)、CD4^(+)/CD8^(+)水平均低于麻醉前,研究组高于对照组,差异有统计学意义(P<0.05);研究组麻醉优良率高于对照组,差异有统计学意义(P=0.046);两组麻醉不良反应发生率比较,差异无统计学意义(P>0.05)。结论:应用七氟烷和丙泊酚全麻复合硬膜外阻滞麻醉,能够使患者尽快苏醒,提高患者免疫功能及麻醉优良率,且安全性较高。

全麻联合硬膜外阻滞与腹横肌平面阻滞对结直肠癌根治术患者术后恢复的影响

目的结直肠癌根治术围术期镇痛方案的选择尚存在争议。文中旨在比较全麻分别联合硬膜外阻滞与腹横肌平面阻滞对患者手术恢复的影响,为结直肠癌根治术镇痛方式的选择提供依据。方法回顾性分析2016年2月至2018年5月于南通大学附属医院118例行全麻下腹腔镜结直肠癌根治术患者临床资料。对所有纳入的研究对象按照麻醉方案分为硬膜外阻滞组(n=61)和腹横肌平面阻滞组(n=57)。2组患者全麻诱导及维持用药一致。记录2组患者术中全麻药物用量,比较术后恢复情况,包括肛门首次排气、进食时间、下床活动时间、住院时间及疼痛视觉模拟评分等,检测不同时间点心率、平均动脉压(M AP)、血氧饱和度(SpO2)、皮质醇(Cor)、去甲肾上腺素(N E)等应激指标,CD4+、CD8+、CD4+/CD8+、总T淋巴细胞计数、自然杀伤细胞(N K)计数等免疫指标,以及人趋化因子CXC配体8(CXCL8)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)等炎症指标的变化。结果硬膜外阻滞组舒芬太尼用量低于腹横肌平面阻滞组([25.36±4.74)g vs(28.43±3.69)g,P<0.01];硬膜外阻滞组患者肛门首次排气时间、进食时间、首次下床活动时间均少于腹横肌平面阻滞组(P<0.05);硬膜外阻滞组术后不同时间点VAS评分皆低于腹横肌平面阻滞组(P<0.01);硬膜外阻滞组气腹建立后5min至放气后5min心率、MAP、Cor、NE均低于腹横肌平面阻滞组相应时间点,气腹建立后5 min SpO2低于同时间点腹横肌平面阻滞组([5.11±0.31)%vs(5.96±0.34)%,P<0.05]。术后24h,硬膜外阻滞组CD8+([20.79±13.02)%v(2s 6.91±10.22)%]、总T细胞([60.23±8.97)%v(6s 4.33±12.76)%]低于腹横肌平面阻滞组,CD4+/CD8+([1.66±0.63)v s(1.25±0.95)、]NK细胞计数([27.71±10.98)%v(2s 0.02±1.74)%]高于腹横肌平面阻滞组,差异均有统计学意义(P<0.05);CXCL8、IL-6、TNF-α水平低于腹横肌平面阻滞组,差异均有统计学意义(P<0.05)。2组患者不良反应发生率比较,差异无统计学意义(3.28%vs 5.26%,P>0.05)。结论全麻联合硬膜外阻滞可减少结直肠癌根治术中麻醉药物用量,减轻机体应激及炎症反应,同时对早期免疫抑制作用较弱,整体镇痛效果优于联合腹横肌平面阻滞。

全身麻醉联合连续椎旁神经阻滞在胸腹腔镜联合食管癌根治术中的应用

目的研究全身麻醉联合连续椎旁神经阻滞应用于食管癌根治术效果。方法选择广东省梅州市人民医院胸外科2016年5月-2017年12月收治食管癌根治术患者90例为研究对象,随机分为3组, A组(n=30)采取气管内插管全身麻醉下完成食管癌根治术,B组(n=30)采取全身麻醉联合硬膜外阻滞下完成手术治疗;C组(n=30)采取全身麻醉联合连续椎旁神经阻滞。比较3组患者不同时间点心率(HR)、平均动脉压(MAP)、术中七氟烷、舒芬太尼用量,苏醒相关指标和不良反应发生率。结果与A组比较,B组患者T_1、T_2、T_3、T_4时刻MAP降低,T_1、T_2、T_3时刻HR降低,差异均有统计学意义(P<0.05);C组患者T_2、T_3时刻MAP降低,T_2时刻HR降低,差异均有统计学意义(P<0.05); B、C组患者七氟烷、舒芬太尼用量、拔管后5 min视觉模拟评分法(VAS)评分均降低,睁眼时间、定向力恢复时间、拔管时间、呼吸恢复时间均缩短,差异均有统计学意义(P<0.05)。3组患者不良反应比较,差异无统计学意义(P>0.05)。结论全身麻醉联合连续椎旁神经阻滞应用于食管癌根治术血流动力学平稳,且可减少麻醉药物用量,应用安全。

连续硬膜外麻醉复合全身麻醉食管癌根治术中罗哌卡因最适浓度的探究

目的 探究连续硬膜外麻醉复合全身麻醉食管癌根治术中罗哌卡因的最适浓度。方法 选取2015年1—10月于内蒙古医科大学附属医院拟采用连续硬膜外麻醉复合全身麻醉行侧开胸食管癌根治术的患者80例，采用随机数字表法将患者按硬膜外用药浓度分为4组，每组20例。A组硬膜外麻醉使用罗哌卡因浓度为0.25%；B组罗哌卡因浓度为0.20%；C组罗哌卡因浓度为0.15%；D组罗哌卡因浓度为0.10%。4组均行第8-10胸椎间隙硬膜外穿刺，头向置管4 cm，各组给予相应浓度的罗哌卡因试验剂量5 ml，确定硬膜外麻醉有效并排除异常阻滞情况后开始全身麻醉诱导。各组硬膜外给予对应浓度首次维持剂量8 ml,术中每1 h追加维持剂量5 ml。全身麻醉维持采用静脉持续输注丙泊酚和瑞芬太尼，使脑电双频指数值保持在40-60。术中酌情给予麻黄素、多巴胺、去氧肾上腺素，以维持平均动脉压（MAP）〉60 mmHg（1 mmHg=0.133 kPa）。记录并比较4组入室时、给予试验剂量（5 ml）后5 min、插管后5 min、给予首次维持剂量（8 ml）后10 min、切皮时、给予第2次维持剂量（5 ml）后10 min以及拔管时的心率、收缩压、舒张压和MAP，记录血管活性药物的种类及用量、全身麻醉药物用量、清醒拔管时间以及术后疼痛视觉模拟量表（VAS）评分。结果 4组患者在给予首次维持剂量后10 min、切皮时、给予第2次维持剂量后10 min和拔管时的心率、收缩压、舒张压和MAP均低于入室时，D组的心率、收缩压和MAP均高于A、B、C组，差异均有统计学意义（均P＜0.05）。A、B组血管活性药物应用麻黄素、多巴胺和去氧肾上腺素，C、D组应用麻黄素和去氧肾上腺素。A、B、C组麻黄素用量比较，差异无统计学意义（P＞0.05），D组麻黄素用量低于A、B、C组［（6.7±3.8）mg比（15.2±3.1）、（14.6±2.8）、（14.3±2.4）mg］，B组多巴胺用量低于A组［（22±4）mg比（37±6）mg］，A、B、C、D组去氧肾上腺素用量逐一减少［（957±23）、（510±18）、（205±15）μg比（81±17）μg］，差异均有统计学意义（均P＜0.05）。D组丙泊酚用量高于A、B、C组［（1 036±26）mg比（732±26）、（708±25）、（722±22）mg］，差异均有统计学意义（均P＜0.05）；4组瑞芬太尼、罗库溴铵用量比较，差异均无统计学意义（均P＞0.05）。4组患者拔管时间和出室前动、静态VAS评分比较，差异均无统计学意义（均P＞0.05）。结论 0.15%的罗哌卡因足以阻断胸部的交感与感觉神经，能够稳定血流动力学，是复合全身麻醉完成胸科手术的最适硬膜外用药浓度。

不同麻醉方法对子宫颈癌手术患者免疫功能的影响

目的探讨不同麻醉方法对子宫颈癌手术患者免疫功能的影响。方法选择子宫颈癌手术患者72例,随机分为两组,全麻组(A组),硬膜外麻醉组(B组),每组36例。用不同麻醉方法对患者进行麻醉。分别于麻醉前、麻醉后2h、术后1、3、5、7d抽取静脉血,用流式细胞仪测定T淋巴细胞亚群及自然杀伤细胞(NK细胞)的数量。结果与麻醉前相比,两组患者麻醉后2hCD3+、CD4+、CD4+/CD8+、NK细胞的数量均有所下降(P<0·05);术后1d各指标下降显著(P<0·05,P<0·01)。组间比较,麻醉后2h至术后3d虽然两组患者的CD3+、CD4+、CD4+/CD8+、NK细胞的数量都较麻醉前有所下降,但A组下降显著大于B组。结论硬膜外麻醉用于子宫颈癌手术,对于保护患者围术期的免疫功能有一定优越性。

不同麻醉方式对小细胞肺癌围手术期免疫功能的影响

目的:观察全麻和全麻复合硬膜外阻滞麻醉对小细胞肺癌患者围手术期免疫功能的影响。方法:前瞻性将2013年6月至2015年6月期间60例确诊为小细胞肺癌的患者根据麻醉方式的不同分为对照组和观察组,对照组行常规全身麻醉,观察组行全身麻醉复合硬膜外阻滞麻醉,对比两组患者围手术期T细胞和NK细胞水平变化情况。结果:两组患者在T1、T2时点较T0时点CD3+、CD4+水平逐渐降低、CD8+水平逐渐增高、CD4+/CD8+和NK细胞水平逐渐降低,比较差异均有显著统计学意义(P<0.05),组间各时点免疫细胞水平比较差异无统计学意义(P>0.05);T3、T4、T5时点免疫细胞水平逐渐恢复,T5时点观察组各项免疫细胞水平基本恢复至T0时刻水平,对照组仍低于T0时刻,但均明显高于T2时刻水平,组内和组间比较差异均有显著统计学意义(P<0.05)。结论:全麻联合硬膜外阻滞麻醉对小细胞肺癌根治术患者围手术期免疫功能影响较轻微,术后恢复较快,可作为首选的麻醉方式。

硬膜外阻滞联合全身麻醉对老年肺癌根治术患者认知功能及细胞免疫功能的影响

目的探讨硬膜外阻滞联合全身麻醉对老年肺癌根治术患者认知功能及细胞免疫功能的影响。方法采用查随机数字表法将40例老年肺癌根治术患者随机分为观察组和对照组,每组20例。观察组采用硬膜外阻滞联合全身麻醉,对照组采用静脉全身麻醉。用酶联免疫吸附试验(ELISA)双抗体夹心法测定CD3^+、CD4^+、CD8^+、CD4^+/CD8^+细胞和NK细胞水平,简易智力状态检查表(MMES)评估认知功能,VAS评分法及Ramsay镇静评分法评估疼痛和镇静状况,并观察两组患者手术时间、术后恢复自主呼吸时间、苏醒时间以及拔管时间。结果观察组患者手术时间、术后恢复自主呼吸时间、苏醒时间以及拔管时间均优于对照组(P<0.05),但两组患者术后6 h、12 h VAS疼痛评分和Ramsay镇静评分差异均无统计学意义(P>0.05)。两组患者术后1 d CD3^+、CD4^+、CD4^+/CD8^+、NK细胞水平均低于术前(P<0.05);CD8^+细胞水平高于术前(P<0.05);观察组患者术后1 d和7 d CD3^+、CD4^+、CD4^+/CD8^+、NK细胞水平均显著高于对照组(P<0.05),但CD8^+细胞水平与对照组比较差异无统计学意义(P>0.05)。术后7 d两组患者CD3^+、CD4^+、CD4^+/CD8^+、NK细胞水平明显高于术后1 d(P<0.05),CD8^+细胞水平明显低于术后1 d(P<0.05);观察组术后7 d CD3^+、CD4^+、CD4^+/CD8^+、NK细胞水平明显高于对照组(P<0.05),CD8^+细胞水平明显低于对照组(P<0.05)。两组患者MMES评分均显著低于术前(P<0.05),但观察组评分高于对照组;术后认知功能障碍发生率亦低于对照组(P<0.05)。结论硬膜外阻滞联合全身麻醉对老年肺癌根治术后认知功能影响较小,同时可促进细胞免疫功能恢复。

快速康复食管癌外科的麻醉管理分析

目的:通过比较静脉全麻与静脉全麻加硬膜外阻滞对食管癌患者术后情况的影响,分析快速康复食管癌外科的麻醉管理。方法:选取年龄在70岁以下,ASA分级Ⅰ～Ⅱ级,无特殊并发症的食管癌手术患者80例,随机分成两组,每组40例,分别采用静脉全麻(对照组)和静脉全麻加硬膜外阻滞(研究组)的方法处理,测定两组患者在手术过程中的循环功能和呼吸功能的变化,麻醉用药量以及麻醉恢复时间的差异。结果:研究组在麻醉诱导前、插管后、切皮后和拔管时平均动脉压[(13.10±1.67)kPa,(12.89±1.22)kPa,(11.08±1.76)kPa,(12.80±1.45)kPa]和心率[(85.82±9.98)次/min,(86.44±9.25)次/min,(72.23±9.78)次/min,(84.19±8.97)次/min])较对照组的平均动脉压[(12.91±1.28)kPa,(14.83±1.39)kPa,(11.79±1.25)kPa,(12.66±1.28)kPa]和心率[(85.78±9.22)次/min,(98.08±9.10)次/min,(74.82±7.88)次/min,(88.80±1.45)次/min]显著稳定(P<0.05);较麻醉诱导前,对照组[RR(18.75±2.44)次/min,MV(7.76±0.78)L,SpO2(97.00±0.74)%)]和研究组[RR(18.69±2.57)次/min,MV(7.55±0.82)L,SpO2(97.29±0.88)%]患者拔管后的呼吸功能表现为明显抑制(P<0.01);研究组麻醉剂普鲁卡因、潘库溴铵和芬太尼用量[(425.21±72.65)mg,(7.68±1.26)mg,(1.01±0.08)mg]明显低于对照组[(584.18±66.78)mg,(10.07±1.78)mg,(1.92±0.17)mg](P<0.05);麻醉恢复情况也有显著差异(P<0.05)。结论:静脉全麻加硬膜外阻滞的方法能够有效降低手术中的应激,减少麻醉剂量,减少恢复时间,在术中血压和心率控制,术后恢复中均优于静脉全麻。

全麻复合胸段硬膜外阻滞减轻老年胃癌根治术患者围术期心肌损伤的研究

目的:探讨全麻复合胸段硬膜外阻滞对老年胃癌根治术患者心肌损伤的影响。方法:选取68例行胃癌根治术老年患者作为研究对象,采用随机数字表法把患者分为A组(34例)和B组(34例)。A组采用全麻复合胸段硬膜外阻滞麻醉,B组采用单纯全麻麻醉。统计麻醉前(T0)、气管插管后(T1)、手术开始时(T2)和手术结束拔除气管导管(T3)时的SBP、DBP、MAP和HR。检测两组在T1~T3的血浆肌酸激酶同工酶MB(CK-MB)和肌钙蛋白(c Tn I)的浓度,采用t检验分析数据。结果:与B组比较,A组在T1、T2、T3的SBP、DBP、MAP和HR明显下降(P<0.05)。A组T1、T2、T3的CK-MB和c Tn I浓度明显低于B组(P<0.05)。结论:全麻复合胸段硬膜外阻滞能减轻老年胃癌根治术患者围术期心肌损伤。

全身麻醉联合连续椎旁神经阻滞应用于食管癌根治术对血流动力学及免疫指标的影响

目的观察全身麻醉联合连续椎旁神经阻滞应用于食管癌根治术血流动力学及对病人免疫指标的影响。方法择期行食管癌根治术病人76例,根据入院顺序编号随机分为两组,对照组38例,于气管内插管全身麻醉下完成食管癌根治术;观察组38例,采取全身麻醉联合连续椎旁神经阻滞。比较两组麻醉前(T_0),插管即刻(T_1),切皮时(T_2),术中1小时(T_3),手术结束即刻(T_4),拔管即刻(T_5)心率(HR)、平均动脉压(MAP)、术中丙泊酚、瑞芬太尼用量,并比较两组T淋巴细胞、NK细胞及CD4/CD8免疫指标,比较两组术中不良反应发生率。结果与对照组比较,观察组T2、T3时刻MAP均降低,且T2时刻HR降低(P<0.05);与对照组比较,观察组手术结束即刻T淋巴细胞、NK细胞及CD4/CD8水平均更高(P<0.05);观察组丙泊酚、瑞芬太尼用量均低于对照组[(62.9±9.8)vs(88.6±10.3)μg/kg·min;(0.10±0.04)vs(0.15±0.03)μg/kg·min](P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论全身麻醉联合连续椎旁神经阻滞应用于食管癌根治术血流动力学平稳,且可减少麻醉药物用量,抑制免疫功能降低。

全身麻醉联合硬膜外阻滞对腹腔镜胃癌根治术患者POCD的影响

目的 探讨全身麻醉联合硬膜外阻滞对腹腔镜胃癌根治术患者术后认知功能障碍(POCD)的影响。方法 将62例行腹腔镜胃癌根治术的患者随机分成两组,分别采用单纯全身麻醉(对照组,n=31)、全身麻醉联合硬膜外阻滞(联合组,n=31)。比较两组的围术期相关指标、血流动力学及POCD的发生情况。结果 联合组丙泊酚用量较对照组明显减少(P<0.05);从T2时刻起,对照组HR水平较T_0时刻显著升高,MAP水平则显著降低(P<0.05),且联合组T_2、T_3、T_4时刻的MAP水平明显高于对照组(P<0.05)。术后1天,对照组MMSE评分较术前明显降低,且低于联合组(P<0.05);联合组POCD的发生率显著低于对照组(P<0.05)。结论 全身麻醉复合硬膜外阻滞用于腹腔镜胃癌根治术减少麻醉药物用量,维持血流动力学稳定,提高术后认知能力。