全麻联合硬膜外阻滞对乳腺癌根治术患者围手术期血清皮质醇含量的影响  

Effect of general anesthesia combined with epidural block on serum cortisol levels in patients undergoing radical mastectomy for breast cancer

作　　者：王娜 姚露 浦明昇[1] WANG Na;YAO Lu;PU Ming-sheng(Department of Anesthesiology,Shanghai Construction Group Hospital,Shanghai 200080,China;Department of Surgery,Shanghai Construction Group Hospital,Shanghai 200080,China)

机构地区：[1]上海建工医院麻醉科,上海200080 [2]上海建工医院外科,上海200080

出　　处：《中国肿瘤临床与康复》2022年第10期1199-1203,共5页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨全麻联合硬膜外阻滞对乳腺癌根治术患者围手术期血清皮质醇含量的影响。方法选取2019年10月至2021年10月间上海建工医院收治的96例女性乳腺癌患者作为研究对象,采用随机数表法分为观察组和对照组,每组48例。两组患者均接受乳腺癌根治术治疗,其中对照组单纯给予全身麻醉,观察组给予全麻联合硬膜外阻滞,比较两组C-反应蛋白(CRP)水平、血清皮质醇(Cor)水平、心率(HR)、平均动脉压(MAP)以及CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)情况。结果术前,两组CRP、Cor水平比较,差异无统计学意义(P>0.05);术后,两组各时间点CRP、Cor水平比较,差异均有统计学意义(P<0.05)。两组T_(0),T_(1)时刻HR、MAP比较,差异无统计学意义(P>0.05);观察组T_(2)、T_(3)、T_(4)时刻HR、MAP均低于对照组,差异有统计学意义(P<0.05)。两组术前及术后48h CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)比较,差异无统计学意义(P>0.05)。术后4h及术后24h,观察组上述指标均高于对照组,差异有统计学意义(P<0.05)。结论全麻联合硬膜外阻滞可明显降低乳腺癌根治术患者围手术期血清皮质醇水平和CRP水平,改善血流动力学水平,减轻免疫抑制,值得临床推广使用。Objective To investigate the effect of general anesthesia combined with epidural block on serum cortisol levels in patients undergoing radical mastectomy for breast cancer.MethodsA total of 96 breast cancer patients who were treated at Shanghai Construction Group Hospital from October 2019 to October 2021 were selected.They were randomly divided into an observation group and a control group with 48 patients in each group.All patients underwent radical mastectomy for breast cancer.The observation group was given general anesthesia combined with epidural block and the control group was given general anesthesia alone.The levels of C-reactive protein(CRP),serum cortisol(Cor),heart rate(HR),mean arterial pressure(MAP),and CD3^(+),CD4^(+),CD4^(+)/CD8^(+)levels were compared between the two groups.ResultsBefore the operation,there was no significant difference in the levels of CRP and Cor between the two groups(P>0.05).After the operation,significant differences were observed in the levels of CRP and Cor between the two groups at each time point(all P<0.05).In terms of HR and MAP at T_(0)and T_(1),there was no significant differences between the two groups(P>0.05).HR and MAP at T_(2),T_(3) and T_(4) were lower in the observation group than in the control group(all P<0.05).There was no significant difference in CD3^(+),CD4^(+),CD4^(+)/CD8^(+)between the two groups before the surgery and at 48 h after the surgery(P>0.05).At 4 h and 24 h after the surgery,the above indexes were higher in the observation group than in the control group(all P<0.05).ConclusionGeneral anesthesia combined with epidural block can significantly reduce perioperative serum cortisol and CRP levels,improve hemodynamics,and relieve immunosuppression in patients undergoing radical mastectomy for breast cancer,which is worthy of clinical promotion.

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分 类 号：R737.9[医药卫生—肿瘤]