不同麻醉方式对老年腹部肿瘤手术患者术后免疫功能及血清IL-6、TNF-α水平的影响  

Effect of different anesthesia methods on postoperative immune function and serum levels of IL-6 and TNF-α in elderly patients with abdominal tumor

作　　者：李国臻 李军祥 何之学 张鲲 LI Guo-zhen;LI Jun-xiang;HE ZHI-xue;ZHANG Kun(Department of Anesthesiology,Chengdu Pidu District Second People's Hospital,Chengdu 611730,China;Department of Anesthesiology,Chengdu Pidu District People's Hospital,Chengdu 611730,China;Department of Anesthesiology,Jiangyin Hospital Affiliated to Southeast University,Wuxi 214400;Department of Anesthesiology,Jingzhou Central Hospital,Jingzhou 434020,China)

机构地区：[1]成都市郫都区第二人民医院麻醉科 [2]成都市郫都区人民医院麻醉科 [3]东南大学附属江阴医院麻醉科 [4]荆州市中心医院麻醉科

出　　处：《现代免疫学》2019年第6期481-484,共4页Current Immunology

摘　　要：为探讨不同麻醉方式对老年腹部肿瘤手术患者术后免疫功能及血清IL-6、TNF-α水平的影响,选择老年腹部肿瘤患者94例,按照随机数字表法分为观察组(47例)、对照组(47例)。对照组采用全身麻醉,观察组采用腰硬联合麻醉复合全身麻醉,比较两组患者术前、手术15 min和术毕血流动力学指标,手术时间、拔管时间和苏醒时间,术前和术后3 d免疫功能及血清IL-6和TNF-α水平变化。观察组手术15 min和术毕心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)低于同期对照组(P<0.05)。两组手术时间比较,差异无统计学意义(P> 0.05)。观察组拔管时间和苏醒时间快于对照组(P<0.01)。观察组术后3 d CD3^+、CD4^+和CD4^+/CD8^+高于对照组(P<0.01)。观察组术后3 d血清IL-6和TNF-α水平低于对照组(P<0.001)。腰硬联合麻醉复合全身麻醉对老年腹部肿瘤手术患者效果明显,对血流动力学、免疫功能及炎症反应影响小。To investigate the effect of different anesthesia methods on postoperative immune function and serum levels of IL-6 and TNF-α in elderly patients with abdominal tumor, 94 elderly patients with abdominal tumor were selected and divided into the observation group(47 cases) and the control group(47 cases) according to random number table method. The control group was treated with general anesthesia, and the observation group was treated with combined spinal epidural anesthesia. The changes of hemodynamics, operation time, extubation time and recovery time, preoperative and postoperative 3 days immune function, serum IL-6 and TNF-α levels were compared between the two groups before operation, 15 min in the operation and after operation. The heart rate(HR) and the mean arterial pressure(MAP) in the observation group were lower than those in the control group at operation 15 min and after operation(P < 0.05). There was no significant difference in operation time between the two groups(P > 0.05);the extubation time and recovery time in the observation group were faster than those in the control group(P < 0.01). The levels of CD3^+, CD4^+ and CD4^+/CD8^+ in the observation group postoperative 3 days were significantly higher than those in the control group(P < 0.01);the levels of IL-6 and TNF-α in the observation group postoperative 3 days were significantly lower than those in the control group(P < 0.001). The results show that combined spinal epidural anesthesia has beneficial effect on elderly patients with abdominal tumor operation, and has very limited influence on hemodynamics, immune function and inflammatory reaction.

关 键 词：不同麻醉方式 腹部肿瘤手术 免疫功能 白细胞介素6 肿瘤坏死因子Α 

分 类 号：R826.2[医药卫生—临床医学]