全麻复合硬膜外麻醉对腹腔镜下子宫全切术患者免疫应激反应的影响  

Effects of immune function after laparoscopic total uterous resection under general anesthesia combined with epidural anesthesia

作　　者：杨建兵[1] 刘建平[1] 

机构地区：[1]长沙市妇幼保健院麻醉科,湖南长沙410007

出　　处：《中国内镜杂志》2006年第6期638-640,共3页China Journal of Endoscopy

摘　　要：目的研究全麻(generalanesthesia,GA)和全麻复合硬膜外麻醉(generalanesthesiacombinedwithepiduralanesthesia,GE)内镜下子宫全切术对机体免疫应激功能的影响。方法监测60例(GE及GA各30例)内镜下子宫全切术患者术前、术后第1天、术后第2天的外周血淋巴细胞(PBL)亚群、血清免疫球蛋白IgG、IgM、IgA、C反应蛋白(CRP)以及白细胞介素-6(IL-6)和肿瘤坏死因子(TNF-α)的变化并行对比研究。结果两组患者围术期各时点PBL亚群均无明显改变,组间各对应时点比较差异亦无显著性。两组术后24h血清IgG均有下降(P<0.01),但GA组较GE组下降更明显(P<0.05),且持续超过72h。在术后72h内,CRP较术前明显升高(P<0.01),且两组比较GA组明显高于GE组(P<0.01)。两组术后24h血清IL-6明显高于术前(P<0.05),GA组72h后仍未回到术前水平。结论GE对机体免疫及细胞因子水平影响较小,有利于病人恢复。[Objective] To evaluate the effects of immune function after lapamscopic total uterous resection under general anesthesia combined with epidural anesthesia. [Methods] Sixty patients who received lapamscopic total uterous resection were divided into general anesthesia group （GA, n =30） and general anesthesia combined with epidural anesthesia group （GE, n =30）. Immune parameters including serum immuolobulins （IgG, IgA, IgM） and T cell subsets, and Interleukin-6,CRP,TNF-α levels were assessed preoperatively and on postoperative days 1 and 2. [Results] The T cell subsets did not change after operation, but the level of serum igG was significantly decreased after operation, especially in GA group（P 〈0.05）. The level of serum CRP in both groups were significantly increased in three days after operation, and more higher in GA group （P 〈0.01）. The level of serum IL-6 in both groups were significantly increased after operation, and went on more than three days （P 〈0.05）. [Conclusions] The immune response was less in GE group patients than in GA group patients. It appears that GE is better for patients with laparoscopie total uterous resection.

关 键 词：内镜 全身麻醉 硬膜外阻滞 子宫全切术 免疫应激反应 

分 类 号：R614.42[医药卫生—麻醉学]