全麻复合硬膜外麻醉对结肠癌患者术后应激反应、炎症反应水平及凝血功能的影响  

Effect of general anesthesia combined with epidural anesthesia on stress response,inflammatory reaction and coagulation in patients with colon cancer

作　　者：易思杨 张先杰[1] 周裕凯[1] 汪亚丽[2] 游星 YI Si-yang;ZHANG Xian-jie;ZHOU Yu-kai;WANG Ya-li;YOU Xing(Clinical Laboratory,People＇s Hospital of Deyang City,Deyang 618000,China;Anesthesiology Department,People＇s Hospital of Deyang City,City,Sichuan Deyang 618000,China)

机构地区：[1]德阳市人民医院麻醉科,四川德618000 [2]德阳市人民医院检验科,四川德618000

出　　处：《海南医学院学报》2018年第18期1678-1682,共5页Journal of Hainan Medical University

基　　金：四川省自然科学基金项目(2012H136)~~

摘　　要：目的:探究全麻复合硬膜外麻醉对腹腔镜结肠癌切除术患者麻醉术中及术后应激反应、炎症反应及凝血功能的影响。方法:选取2015年8月~2017年8月期间于本院接受结肠癌根治术患者98例,随机分为对照组与观察组,均49例。对照组使用全身静脉麻醉,观察组使用全身静脉麻醉复合硬膜外麻醉。分别于麻醉前,麻醉后30min和术后2h采集患者静脉血血清检测应激反应指标促肾上腺皮质激素(ACTH)、肾上腺素(AD)、去甲肾上腺素(NE)、皮质醇(Cor)和炎症反应指标肿瘤坏死因子-α(TNF-α)、血清降钙素原(PCT)、C-反应蛋白(CRP);于相同时间点采集静脉血进行凝血功能指标凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FBG)检测。结果:两组麻醉前各项指标水平差异无统计学意义(P>0.05)。麻醉后30min及术后2h,观察组患者的各项应激反应指标和各项炎症反应指标水平均低于同时间点对照组的对应指标;观察组患者的凝血功能指标PT、APTT、TT水平均高于同时间点对照组的对应指标,而FBG含量则低于对照组同时间点FBG的含量,差异均有统计学意义(P<0.05)。结论:全麻复合硬膜外麻醉可有效降低腹腔镜结肠癌切除术患者术中和术后早期的应激反应和炎症反应,并改善患者凝血功能异常,减轻血液高凝状态。Objective： To investigate the effects of general anesthesia combined with epidural anesthesia on stress response, inflammation level and coagulation function in patients undergoing laparoscopic colon cancer resection during intraoperative and postoperative. Methods： A total of 98 patients undergoing colon cancer radical surgery in our hospital from August 2015 to August 2017 were randomly divided into control group and observation group, with 49 cases in each group. In the control group, systemic intravenous anesthesia was used; and in the observation group, a systemic intravenous anesthesia combined epidural anesthesia was used. Serum of venous blood was collected from patients before anaesthesia, 30 minutes after anesthesia, and two hours after operation to detect stress response indexes, such as adreno-cortico-tropic-hormone （ACTH）, adrenaline （AD）, norepinephrine （NE） and cortisol （Cor）, and inflammatory response indexes, such as tumor necrosis factor-α （TNF-α）, procalcitonin （PCT） and C-reaction protein （CRP）. Venous blood was collected at the same time points for coagulation testing. Functional indicators such as prothrombin time （PT）, activated partial thromboplastin time （APTT）, thrombin time （TT） and fibrinogen （FBG） were detected. Results： There was no significant difference in the level of each index between the two groups before anesthesia （ P 〉0.05）. At 30 minutes after anesthesia and at 2 hours after operation, the stress response indicators and inflammatory response indicators in the observation group were lower than those in the control group at the same time points; apart of the blood coagulation function indexes （PT, APTT and TT） in the observation group were higher than the corresponding indicators of the control group at the same time points, but the FBG content in the observation group was lower than that of the control group at the same time points, and these differences were significant （ P 〈0.05）. Conclusion： The method

关 键 词：硬膜外麻醉 结肠癌 应激 炎症反应 凝血功能 

分 类 号：R614[医药卫生—麻醉学] R735.35[医药卫生—外科学]