全凭静脉麻醉复合硬膜外神经阻滞及硬膜外自控镇痛在宫颈癌患者中的应用价值  

Application Value of Total Intravenous Anesthesia Combined with Epidural Nerve Block and Patient-Controlled Epidural Analgesia in Patients with Cervical Cancer

作　　者：李园 暴桂萍 郑斌 LI Yuan;BAO Guiping;ZHENG Bin(Department of Anesthesiology,Puyang Maternal and Child Health Hospital,Puyang 457001,China)

机构地区：[1]濮阳市妇幼保健院麻醉科,河南濮阳457001

出　　处：《河南医学研究》2022年第12期2198-2201,共4页Henan Medical Research

摘　　要：目的探讨全凭静脉麻醉复合硬膜外神经阻滞及硬膜外自控镇痛(PCEA)在宫颈癌患者中的应用效果。方法选取2019年4月至2020年4月濮阳市妇幼保健院收治的94例宫颈癌患者。根据麻醉方案分为全麻组(47例)和复合组(47例)。给予两组患者腹腔镜手术治疗。全麻组采用全凭静脉麻醉,复合组采用全凭静脉麻醉复合硬膜外神经阻滞。两组患者术后均接受PCEA。比较两组患者的麻醉效果、术后恢复情况(自主呼吸恢复时间、清醒时间、首次排气时间、术后下床活动时间)、不良反应情况,以及术前、术后4 h、术后1 d、术后2 d患者血清T淋巴细胞亚群水平(CD3^(+)、CD4^(+)/CD8^(+))。比较两组术前、术后2 d氧化应激指标,包括单胺氧化酶A(MAOA)、谷胱甘肽过氧化物酶(GSH-Px)。结果复合组麻醉效果优于全麻组(P<0.05)。复合组术后自主呼吸恢复时间、清醒时间、首次排气时间、术后下床活动时间短于全麻组(P<0.05)。两组血清T淋巴细胞亚群水平均呈先降低再升高的趋势。复合组术后4 h、1 d血清CD3^(+)、CD4^(+)/CD8^(+)水平高于全麻组(P<0.05)。术后2 d,两组血清GSH-Px水平低于术前,MAOA水平高于术前(P<0.05);术后2 d,复合组血清GSH-Px水平高于全麻组,MAOA水平低于全麻组(P<0.05)。复合组不良反应发生率较全麻组低(P<0.05)。结论全凭静脉麻醉复合硬膜外神经阻滞及PCEA应用于宫颈癌的麻醉效果显著,能促进患者术后恢复,减轻氧化应激反应,维持血清T淋巴细胞亚群水平稳定,减少不良反应发生。Objective To explore the application effect of total intravenous anesthesia combined with epidural nerve block and patient-controlled epidural analgesia(PCEA)in patients with cervical cancer.Methods From April 2019 to April 2020,94 patients with cervical cancer were selected from Puyang Maternal and Child Health Hospital.According to the anesthesia scheme,they were divided into general anesthesia group(47 cases)and compound group(47 cases).The patients in two groups were treated with laparoscopic surgery.The patients in general anesthesia group were treated with total intravenous anesthesia,while the patients in compound group were treated with total intravenous anesthesia combined with epidural nerve block.PCEA was used in both groups after operation.The anesthetic effect,postoperative recovery(recovery time of spontaneous breathing,waking time,first exhaust time and time of getting out of bed after operation),adverse reactions,and serum T lymphocyte subsets(CD3^(+),CD4^(+)/CD8^(+))before operation,4 hours after operation,1 day after operation and 2 days after operation were compared between the two groups.The indexes of oxidative stress,including monoamine oxidase A(MAOA)and glutathione peroxidase(GSH-Px),were compared between the two groups before and 2 days after operation.Results The anesthesia effect of compound group was better than that of general anesthesia group(P<0.05).The recovery time of spontaneous breathing,waking time,the first exhaust time and the time of getting out of bed after operation in compound group were shorter than those in general anesthesia group(P<0.05).The levels of serum T lymphocyte subsets in both groups decreased first and then increased.The levels of serum CD3^(+),CD4^(+)/CD8^(+)in compound group were higher than those in general anesthesia group at 4 hours and 1 days after operation(P<0.05).Two days after operation,the serum GSH-Px levels in both groups were lower than those before operation,and the MAOA levels in both groups were higher than those before operation(P<0.05).Two

关 键 词：宫颈癌 全凭静脉麻醉 硬膜外神经阻滞 硬膜外自控镇痛 肛门首次排气时间 T淋巴细胞亚群 

分 类 号：R737.33[医药卫生—肿瘤]