| 王 珣,张稳稳,陈 丞,孙洁琼,桑盛银.不同麻醉方法对食管癌手术患者免疫及认知功能的影响[J].,2017,17(17):3363-3366 |
| 不同麻醉方法对食管癌手术患者免疫及认知功能的影响 |
| Effects of Different Anesthesia Methods on Immunity Function and Cognitive Dysfunction in Patients Undergoing Esophageal Cancer |
| 投稿时间：2016-08-23 修订日期：2016-09-20 |
| DOI：10.13241/j.cnki.pmb.2017.17.041 |
| 中文关键词: 全麻复合硬膜外麻醉 食管癌 T细胞水平 认知功能 |
| 英文关键词: General anesthesia combined with epidural anesthesia Esophageal cancer T-cell immunity function Cognitive dys- function |
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| 中文摘要: |
| 摘要 目的：探讨全麻或全麻复合硬膜外麻醉对食管癌手术患者的T细胞水平及术后认知功能的影响。方法：选择2014年1月至2015年12月于我院择期行开胸手术的食管癌患者100例为研究对象，根据手术时间顺序分为观察组（全麻复合硬膜外麻醉）和对照组（全麻），每组50例，观察记录两组患者诱导前、插管时、术中1 h、拔管后的平均动脉压（MAP）、血氧饱和度（SpO2）和心率（HR）；两组患者术前30 min、术后2 h、术后2 d和术后7 d的T细胞亚群水平，包括CD3+、CD4+、CD8+、CD4+/CD8+；两组患者术前1 d，术后6 h，术后1 d，术后3 d的认知功能；术后认知功能障碍（POCD）发生率。结果：诱导前观察组和对照组患者的MAP、SpO2和HR比较，差异均不显著（P>0.05），插管时、术中1h和拔管后观察组患者的MAP和HR水平均明显低于对照组（P<0.05），而SpO2明显高于对照组（P<0.05）。术后2 h，观察组和对照组的CD3+、CD4+、CD8+、CD4+/CD8+值均较术前30 min明显降低（P<0.05），但两组间各指标值无显著性差异（P<0.05）；术后2 d，观察组的CD3+、CD4+、CD8+、CD4+/CD8+值均明显高于对照组（P>0.05）。术后7 d，两组的T细胞亚群水平均较术前30 min无显著性差异（P>0.05）。术后6 h和术后1 d，两组的MMSE评分均较术前1 d明显下降（P<0.05），观察组术后1 d、3 d和7 d的MMSE评分均明显高于对照组（P<0.05）。术后6 h，观察组的POCD发生率明显低于对照组（P<0.05），术后1 d和3 d观察组的POCD发生率低于对照组，但无统计学差异（P>0.05）。结论：与单凭全麻比较，全麻复合硬膜外麻醉对食管癌手术患者的T细胞水平及术后认知功能的影响较小，术后恢复快。 |
| 英文摘要: |
| ABSTRACT Objective: To compare the effects of general anesthesia combined with epidural anesthesia and general anesthesia on t-cell immunity function and postoperative cognitive dysfunction in patients undergoing esophageal cancer. Methods: 100 cases of pa- tients undergoing esophageal cancer in our hospital from January 2014 to December 2015 were divided into observation group(n=50, general anesthesia combined with epidural anesthesia) and control group(n=50, general anesthesia). The MAP, SpO2, HR and the levels of CD3+, CD4+, CD8+ and CD4+/CD8+ in two groups were compared. Results: There was no significant differences in the mean arterial pressure(MAP), SpO2 and heart rate(HR) before the induction between two groups（P>0.05）; During intubation, intraoperative 1 h and af- ter extubation, MAP and HR of patients in the observation group was significantly lower than that of the control group（P<0.05）, and SpO2 was significantly higher than that of the control group（P<0.05）; after 2 hours of operation, the levels of CD3+, CD4+, CD8+, CD4+ /CD8+ of two groups were significantly lower than that of 30 min of preoperation（P<0.05）, but there was no significant differences be- tween two groups（P>0.05）; After 2 d of operation, the levels of CD3+, CD4+, CD8+, CD4+/CD8+ of the observation group was signifi- cantly higher than that of the control group（P<0.05）; After 7 d of operation, the levels of CD3+, CD4+, CD8+, CD4+/CD8+ of two groups were back to normal. After 6 h and 1 d of operation, MMSE scores of two groups were significantly lower than that of 1 day of preopera- tion（P<0.05）, MMSE scores of the observation group was significantly higher than that of the control group after 1,3,7 d of operation（P<0.05）; after 6 h of operation, POCD incidence rate of the observation group was significantly lower than that of the control group(P< 0.05). Conclusion: Compared with general anesthesia, general anesthesia combined with epidural anesthesia can effectively reduce the influence to t-cell immunity function and postoperative cognitive dysfunction in patients undergoing esophageal cancer. |
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