硬膜外阻滞复合全麻与全凭静脉麻醉在宫颈癌手术中的效果比较  

Comparison of the effect of Epidural Block Combined with General Anesthesia and Total Intravenous Anesthesia on the Cervical Cancer Surgery

作　　者：陈芳[1] 钱敏[1] 纪金芬 李霞[2] 陈蒋东 CHEN Fang;QIAN Min;JI Jin-fen;LI Xia;CHEN Jiang-dong(Department of Anesthesiology,Zhangjiagang hospital of traditional Chinese medicine affiliated to nanjing university of traditional Chinese medicine,Suzhou,Jiangsu,215600,China;Operating Room,Zhangjiagang hospital of traditional Chinese medicine affiliated to nanjing university of traditional Chinese medicine,Suzhou,Jiangsu,215600,China)

机构地区：[1]江苏省南京中医药大学附属张家港市中医医院麻醉科,江苏苏州215600 [2]江苏省南京中医药大学附属张家港市中医医院手术室,江苏苏州215600

出　　处：《现代生物医学进展》2019年第22期4367-4370,共4页Progress in Modern Biomedicine

基　　金：江苏省科技厅社会发展项目(BC2008625)

摘　　要：目的:对比硬膜外阻滞复合全麻与全凭静脉麻醉在宫颈癌手术中的效果。方法:选择2016年1月~2018年12月我院收治的90例宫颈癌患者,均采取腹腔镜宫颈癌根治术治疗,将其随机分为两组。对照组采用全凭静脉麻醉方法,观察组采用硬膜外阻滞复合全麻方法。比较两组的术后感染率、拔管时间以及苏醒时间,术前、术后12 h和术后72 h的血清肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平、CD3^+、CD4^+/CD8^+、CD8^+、CD4^+的变化。结果:观察组术后感染率、拔管时间以及苏醒时间均明显低于对照组(P<0.05);观察组患者术后12 h的血清TNF-α以及IL-6水平明显低于术前和对照组(P<0.05),两组术后72 h的血清TNF-α和IL-6水平均恢复至术前水平;两组术后12 h的CD3^+、CD4^+/CD8^+、CD4^+均明显低于术前(P<0.05),且观察组术后12 h的CD3^+、CD4^+/CD8^+、CD4^+明显高于对照组(P<0.05),两组术后72 h的CD3^+、CD4^+/CD8^+、CD8^+、CD4^+均恢复至术前水平。结论:与全凭静脉麻醉相比,硬膜外阻滞复合全麻更有助于宫颈癌手术患者早期拔管和苏醒,其可明显减轻患者术后的免疫抑制,有效降低术后感染发生率。Objective: To compare the effect of epidural block combined with general anesthesia and total intravenous anesthesia inon the cervical cancer surgery. Methods: Selected 90 cases of patients with cervical cancer surgery who were treated in our hospital from January 2016 to December 2018, were selected and randomly divided into two groups randomly. The control group was given total intravenous anesthesia, while the observation group was given epidural anesthesia combined with general anesthesia. The postoperative infection rate, extubation time and recovery time, changes of the serum TNF-α and IL-6 levels, CD3^+, CD4^+/CD8^+, CD8^+and CD4^+levels before surgery, at 12 h and 72 h after surgery, 72 h surgery were compared between the two groups. Results: The infection rate, extubation time and recovery time in the observation group were significantly lower than those in the control group(P < 0.05). The serum TNF-αand IL-6 levels of cervical cancer patients in the observation group were significantly lower at 12 h after surgery than those before surgery and in the control group(P < 0.05). The serum TNF-α and IL-6 levels in both groups recovered to the preoperative levels at 72 h after surgery. The levels of CD3^+, CD4^+/CD8^+, CD4^+in the two groups at 12 h after operation were significantly lower than those before operation(P< 0.05). The levels of CD3^+, CD4^+/CD8^+, CD4^+in the observation group at 12 h after operation were significantly higher than those in the control group(P < 0.05). The levels of CD3^+, CD4^+/CD8^+CD4^+in both groups recovered to the preoperative levels at 72 h after surgery. Conclusion: Compared with total intravenous anesthe sia, epidural anesthesia combined with general anesthesia is more conducive to the early extubation and revive of cervical cancer patients, it significantly alleviatinges the postoperative immunosuppression and effectively reducinges the incidence of postoperative infection.

关 键 词：硬膜外阻滞复合全麻 全凭静脉麻醉 宫颈癌 术后感染 免疫功能 

分 类 号：R737.33[医药卫生—肿瘤] R614[医药卫生—临床医学]