老年宫颈癌手术全麻复合硬膜外阻滞麻醉效果及对患者心功能、免疫功能影响  

Effects of general anesthesia combined with epidural block anesthesia during operation of elderly patients with cervical cancer on their anesthetic effect,cardiac function,and immunologic function

作　　者：史玉龙 张英丽 SHI Yulong;ZHANG Yingli(The Second Affiliated Hospital of School of Medicine,Zhejiang University,Hangzhou,Zhejiang Province,310009;Chiping District People’s Hospital of Liaocheng,Shandong Province)

机构地区：[1]浙江大学医学院附属第二医院,杭州310009 [2]山东省聊城市茌平区人民医院

出　　处：《中国计划生育学杂志》2023年第5期1087-1093,共7页Chinese Journal of Family Planning

摘　　要：目的:探讨全麻复合硬膜外阻滞麻醉对老年宫颈癌患者手术麻醉效果及对心功能、外周血T细胞亚群的影响。方法:选择本院2019年1月-2023年1月收治并经宫颈组织活检病理确诊的老年宫颈癌患者160例,随机分为对照组和观察组各80例。手术时对照组行全麻,观察组行全麻复合硬膜外阻滞麻醉。记录两组麻醉效果及不良事件;术前、术中及术后清醒时心功能[收缩压(SBP)、舒张压(DBP)、心率(HR)、心排血量(CO)和心脏指数(CI)];术前及术后1d、3d、5d外周血T细胞亚群[CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、然杀伤细胞(NK)]、氧化应激指标[血红素加氧酶-1(HO-1)、丙二醛(MDA)和超氧化物歧化酶(SOD)、血管紧张素(AngⅡ)、去甲肾上腺素(NE)]、炎症因子[白细胞介素-6(IL-6),肿瘤坏死因子-α(TNF-α)及C反应蛋白(CRP)]。结果:两组术后苏醒时间和拔管时间无差异(P>0.05),气管拔管后1~60min,两组Ramsay镇静评分均降低但观察组高于对照组(P<0.05)。两组术中SBP、DBP、HR降低,CO和CI增高术后清醒时两组心功能指标均不同程度恢复到术前水平,但观察组变化幅度低于对照组(均P<0.05);两组术后1d外周血CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、NK、HO-1、SOD均降低,MDA、AngⅡ、NE、IL-6、TNF-α及CRP均增高,术后3d和5d外周血CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、NK、HO-1、SOD均不同程度升高,MDA、AngⅡ、NE、IL-6、TNF-α及CRP均不同程度降低,但观察组各指标变化幅度低于对照组(均P<0.05)。两组围术期均未发生明显不良事件。结论:全麻复合硬膜外阻滞麻醉用于老年宫颈癌手术,麻醉效果提高,对患者心功能、外周血T细胞亚群影响较小。Objective:To investigate the effects of general anesthesia combined with epidural block anesthesia during operation of elderly patients with cervical cancer on their anesthetic effect,cardiac function,and peripheral blood T cell subsets.Methods:160 elderly patients with cervical cancer confirmed by cervical biopsy pathology were selected and were randomly divided into two groups(80 cases in each group)from January 2019 to January 2023.The patients in the control group accepted general anesthesia during operation,and the patients in the observation group accepted the gen-eral anesthesia combined with epidural anesthesia.The anesthetic effect and the adverse events of the patients in the two groups were recorded.The values of the cardiac function indexes,such as systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),cardiac output(CO),and cardiac index(CI),before operation,during opera-tion,and at postoperative wakefulness,the values of the peripheral blood T cell subsets,such as CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),and natural killer cell(NK),before operation and in postoperative 1d,3d,and 5d,the levels of oxidative stress index,such as heme oxygenase-1(HO-1),malondialdehyde(MDA),superoxide dismutase(SOD),angiotensin II(Ang II),and norepinephrine(NE),and the levels of the inflammatory factors,such as interleukin-6(IL-6),tumor necrosis factor-a(TNF-a),and C reactive protein(CRP),of the patients in the two groups were recorded.Results:There were no significant differences in the postoperative recovery time and the extubation time of the patients between the two groups(P>0.05).The Ramsay sedation score of the patients in the two groups in 1 to 60 minutes af-ter extubation had decreased significantly,but which of the patients in the observation group was significantly higher than that of the patients in the control group(P<0.05).The values of SBP,DBP,and HR of the patients during the operation had decreased significantly,while the values of CO and CI of the patients during the operation had incre

关 键 词：老年宫颈癌手术 全麻 硬膜外阻滞麻醉 心功能 免疫功能 麻醉效果 

分 类 号：R614[医药卫生—麻醉学] R737.33[医药卫生—外科学]