Article Summary
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].现代生物医学进展英文版,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
Received:August 23, 2016  Revised:September 20, 2016
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
基金项目:
Author NameAffiliationE-mail
王 珣 江苏省南通大学附属海安医院麻醉科 江苏 南通 226600 wangxun_198412@medicinepaper.cn 
张稳稳 徐州医学院附属医院麻醉科 江苏 徐州221000  
陈 丞 东台市人民医院麻醉科 江苏 盐城 224200  
孙洁琼 江苏省南通大学附属海安医院麻醉科 江苏 南通 226600  
桑盛银 江苏省南通大学附属海安医院麻醉科 江苏 南通 226600  
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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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