不同麻醉和镇痛方法对乳腺癌手术患者T淋巴细胞亚群、细胞因子及应激激素水平的影响  

Effect of different anesthesia and analgesia methods on T lymphocyte subsets,cytokines and stress hormone level in patients with breast cancer surgery

作　　者：马燕[1] 何锡强[1] 王庚[1] 

机构地区：[1]北京积水潭医院麻醉科,北京100035

出　　处：《海南医学院学报》2015年第11期1516-1518,1521,共4页Journal of Hainan Medical University

基　　金：北京市科技计划项目(D120614531409045)~~

摘　　要：目的:探索不同麻醉和镇痛方法对乳腺癌根治术患者围手术期T淋巴细胞亚群、细胞因子及应激激素水平的影响。方法:将拟行根治手术的86例乳腺癌患者随机分作两组,对照组43例采用全凭静脉麻醉,而观察组43例采用全凭静脉麻醉复合硬膜外麻醉,且术后均行自控镇痛。于术前和术后各时间点检测T淋巴细胞亚群、细胞因子及应激激素水平并进行分析、比较。结果:两组T1、T2时CD3+、CD4+、CD4+/CD8+比值均较T0时明显减少,但观察组减少幅度小于对照组,差异有统计学意义(P<0.05);两组T3、T4时各指标均已恢复至T0水平,差异无统计学意义(P>0.05);两组T1、T2、T3时白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平均较T0时明显增加,且观察组增加幅度小于对照组,差异有统计学意义(P<0.05);两组T4时各指标均已恢复至T0水平,差异无统计学意义(P>0.05);两组T1、T2时皮质醇水平较T0时明显增加,且观察组增加幅度小于对照组,差异有统计学意义(P<0.05);两组T3、T4时皮质醇已恢复至T0水平,差异无统计学意义(P>0.05)。结论:全凭静脉麻醉复合硬膜外麻联合术后硬膜外镇痛对乳腺癌根治术患者免疫抑制和应激反应较轻,炎症反应轻,是较为理想的麻醉和镇痛方式。Objective： To explore the effect of different anesthesia and analgesia methods on the T lymphocyte subsets, eytokines and the levels of the stress hormone in patients with breast cancer surgery. Methods： A total of 86 cases of breast cancer were divided into two groups by random digits table, control group of 43 cases with total intravenous anesthesia, and the observation group of 43 cases with total intravenous anesthesia combined with epidural anesthesia and postoperative underwent analgesia. The T lymphocyte subsets, cytokines and the levels of the stress hormone were detected before and after operation and compared. Results： CD3＋ , CD4＋ and CD4＋/CD8＋ of the two groups at T1 or T2 were significantly lower than those at TO, and those in the observation group were significantly lower than the control group （P〈0.05）. IL-6, CRP and TNF-α levels of the two groups at T1, T2 or T3 were significantly higher than those at TO, and those in the observation group were sig- nificantly lower than the control group （P〈0.05）. Each index of two groups at T4 were restored to TO （P〉0.05）. The cortisol levels of two groups at T1 or T2 were significantly increased compared with TO, and the increase in the observation group was less than that of the control group （P〈0.05）. The cortisol levels of two groups at T4 were restored to T0, but the differ- ences were not statistically significant（P〉 0.05）. Conclusion： Epidural analgesia after the intravenous anesthesia combined with epidural anesthesia for breast cancer produces lighter immunosuppression and stress reaction, has less influence on inflam- matory factors, is an ideal anesthesia and analgesia method.

关 键 词：乳腺癌 T淋巴细胞 细胞因子 应激 

分 类 号：R737.9[医药卫生—肿瘤]