不同麻醉方式对腹腔镜子宫切除术患者炎症反应及氧化应激反应的影响  

Effect of different anesthesia methods on inflammation and oxidative stress in patients with laparoscopic hysterectomy

作　　者：王晓光[1] 李戈辉[1] 齐晓非[1] 刘丹勇 

机构地区：[1]深圳市妇幼保健院麻醉科,广东深圳518028

出　　处：《海南医学院学报》2016年第13期1446-1449,1453,共5页Journal of Hainan Medical University

基　　金：2011年深圳市卫生和人口计划生育委员会项目(B2011281)~~

摘　　要：目的：分析不同麻醉方式对腹腔镜子宫切除术患者炎症反应及氧化应激反应的影响。方法：将2012年9月～2015年2月于我院接受腹腔镜子宫切除治疗的患者75例纳入研究,根据具体麻醉方式不同分为单纯全身麻醉组患者40例,全麻复合硬膜外麻醉组患者35例,抽取患者外周静脉血测定炎症相关指标、免疫分子相关指标、脑氧代谢及脑血流、氧化应激相关指标等差异。结果：观察组术后髓鞘碱性蛋白（MBP）、单核细胞趋化蛋白-1（MCP-1）、高迁移率族蛋白1（HMGB1）、脂多糖结合蛋白（LBP）值低于对照组,胰岛素（Ins）值高于对照组（P〈0.05）;观察组术后淋巴细胞表面抗原（CD25）、单核细胞表面抗原（CD14）、CD4＋CD25＋Treg细胞、CD8＋CD28-Treg细胞、Th1细胞百分比高于对照组,Th2细胞、Th17细胞百分比低于对照组（P〈0.05）;观察组手术结束前30min、术后脑动脉血氧含量（CaO2）、颈内静脉血氧含量（CjvO2）、脑动静脉血氧含量差（CajvDO2）值均高于对照组（P〈0.05）;观察组接受治疗后血清五羟色胺（5-HT）、酶酪氨酸羟化酶（TH）、代谢酶单胺氧化酶A（MAOA）值低于对照组,谷胱甘肽过氧化物酶（GSH-Px）、总抗氧化能力（T-AOC）值高于对照组（P〈0.05）。结论：腹腔镜子宫切除患者接受全麻复合硬膜外麻醉,可以有效抑制机体炎症及氧化应激状态,维持免疫状态稳定,具有积极的临床意义。Objective：To analyze the effect of different anesthesia methods on inflammation and oxidative stress in patients with laparoscopic hysterectomy.Methods：A total of 75 cases of patients who received laparoscopic hysterectomy in our hospital from September 2012 to February 2015 were included in the research and divided into simple general anesthesia group40 cases and combined general and epidural anesthesia group 35 cases according to different anesthesia methods.Peripheral venous blood was drawn from patients to detect the differences in inflammation-related indexes,immune molecule-related indexes,cerebral oxygen metabolism as well as cerebral blood flow and oxidative stress-related indexes,etc in it.Results：Postoperative myelin basic protein（MBP）,monocyte chemoattractant protein-1（MCP-1）,high mobility group box 1（HMGB1）and lipopolysaccharide binding protein（LBP）values of observation group were significantly lower than those of control group while insulin（Ins）value was significantly higher than that of control group（P〈0.05）;postoperative CD25,CD14,CD4＋CD25＋T,CD8＋CD28-T and Th1 cell percentage of observation group were significantly higher than those of control group while Th2 cell,Th17cell percentage were significantly lower than those of control group（P〈0.05）;CaO2,CjvO2 and CajvDO2values of observation group 30 min before the end of operation and after operation were significantly higher than those of control group（P〈0.05）;serum 5-hydroxytryptamine（5-HT）,tyrosine hydroxylase（TH）and monoamine oxidase A（MAOA）values of observation group after treatment were significantly lower than those of control group while glutathione peroxidase（GSH-Px）and total antioxidant capacity（T-AOC）values were higher than those of control group（P〈0.05）.Conclusions：Combined general and epidural anesthesia for patients with laparoscopic hysterectomy can effectively inhibit body’s inflammatory and oxidative stress state and maintain stable immune state,and it has

关 键 词：腹腔镜子宫切除术 麻醉 硬膜外 氧化应激 

分 类 号：R614[医药卫生—麻醉学] R713.4[医药卫生—外科学]