硬膜外阻滞复合静脉全麻对乳腺癌根治术患者应激反应及T淋巴细胞亚群的影响被引量：18

Effect of epidural block combined intravenous general anesthesia stress on the stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy

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摘要目的:探讨硬膜外阻滞复合静脉全麻对乳腺癌根治术患者应激反应及T淋巴细胞亚群的影响。方法:选取我院2016年7月~2017年6月择期行乳腺癌根治术88例患者进行研究,随机分为观察组和对照组各44例,2组患者常规术前准备,并常规进行血压、心率、脉搏、血氧饱和度、心电图等监测,对照组采用全凭静脉麻醉,观察组采用硬膜外阻滞复合静脉全麻。2组患者于麻醉前30 mim(T_0)、切皮后1h(T_1)、术后4h(T_2)、术后24h(T_3)、术后48h(T_4)抽取外周静脉血,分别测定白细胞介素-8(IL-8)、干扰素-γ(IFN-γ)、皮质醇(Cor)、催乳素(PRL)、生长激素(GH)及T淋巴细胞亚群(CD3^+、CD4^+、CD8^+),计算CD4^+/CD8^+值。结果:观察组血清IL-8水平T_1、T_2、T_3、T_4时逐渐降低,均低于T_0时(P<0.05),而对照组各时间点无明显差异(P>0.05),观察组T_1、T_2、T_3、T_4时IL-8水平低于对照组(P<0.05);2组血清IFN-γ水平T_1、T_2时无明显变化(P>0.05),T_3、T_4时逐渐升高,均高于T_0时(P<0.05),但2组IFN-γ水平无明显差异(P>0.05)。2组血清Cor水平T_1时达高峰,T_2时降低,均高于T_0时(P<0.05),T_3、T_4时基本恢复至T_0时(P>0.05),观察组T_1、T_2时Cor水平低于对照组(P<0.05);2组血清PRL水平于T_1时达高峰,T_2、T_3、T_4时逐渐下降,均高于T_0时(P<0.05),观察组T_1、T_2、T_3时PRL水平低于对照组(P<0.05);2组血清GH水平于T_1时逐渐升高,T_2时达高峰,T_3、T_4时逐渐降低,均高于T_0时(P<0.05),观察组T_1、T_2、T_3、T_4时GH水平低于对照组(P<0.05)。2组CD3^+在T_1、T_2时逐渐降低,均低于T_0时(P<0.05),T_3、T_4时基本恢复至T_0时(P>0.05),观察组T_1、T_2时CD3^+高于对照组(P<0.05);对照组CD4^+在T_1、T_2、T_3、T_4时逐渐降低,均低于T_0时(P<0.05),而观察组CD4^+在T_1、T_2、T_3、T_4时无明显变化(P>0.05),观察组T_1、T_2、T_3、T_4时CD4^+高于对照组(P<0.05);2组CD8^+在T_1、T_2、T_3、T_4时无明显变化(P>0.05);观察组CD4^+/CD8^+在T_1、T_2时逐渐降低,均低于T_0时(P<0.05),T_3、T_4时基本恢复至T_0时(P>0.05),观察组T_1、T_2时CD4^+/CD8^+高于对照组(P<0.05)。结论:硬膜外阻滞复合静脉全麻乳腺癌根治术可有效减轻患者应激及炎症反应,减轻免疫抑制,有助于术后免疫功能恢复。 Objective:To investigate the effect of epidural block combined with intravenous anesthesia on stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy.Methods:In our hospital from July2016to June2017undergoing radical mastectomy for breast cancer of88patients were randomly divided into observation group and control group of44cases,2patients underwent routine preoperative preparation,and routine blood pressure,heart rate,pulse,oxygen saturation,ECG monitoring,control group with intravenous anesthesia.The observation group was treated with epidural block combined with intravenous anesthesia.2groups of patients before anesthesia,30MIM(T0),1h after skin incision(T1),4h after operation(T2),24h after operation(T3),48h after operation(T4)from peripheral venous blood were measured by interleukin8(IL8)and interferon gamma(IFN gamma),cortisol(Cor),prolactin(PRL),growth hormone(GH)and T lymphocyte subsets(CD3+,CD4+,CD8+),the calculation of CD4+/CD8+value.Results:the serum IL8level of T1,T2,T3and T4decreased gradually,were lower than at T0(P<0.05),and the control group at each time point had no significant difference(P>0.05),T1,T2,T3group,T4IL8levels lower than the control group(P<0.05);the2groups of serum IFN levels T1and T2had no significant change(P>0.05),T3and T4increased gradually,was higher than that of T0(P<0.05),but no significant difference between the2groups of IFN levels(P>0.05).2serum Cor levels peaked at T1,decreased at T2,was higher than that of T0(P<0.05),T3,T4returned to T0(P>0.05),the observation group T1,T2Cor level lower than the control group(P<0.05);the serum PRL levels of2groups reached a peak at T1,T2,T3at the time of T4decreased gradually,was higher than that of T0(P<0.05),T1,T2,T3of the observation group at the PRL level is lower than the control group(P<0.05);the serum level of GH2in group T1increased gradually,reached a peak at T2,T3and T4decreased gradually,was higher than that of T0(P<0.05),the observation group T1,T2,T3,T4,GH levels lower than the control group(P<0.05).2groups of CD3+decreased gradually in T1,T2,were lower than T0(P<0.05),T3,T4returned to T0(P>0.05),the observation group T1,T2CD3+was higher than the control group(P<0.05);group CD4+decreased gradually in T1,T2,T3and T4were lower than control,T0when(P<0.05),and the observation group CD4+in T1,T2,T3,T4(P>0.05),no significant changes were observed in group T1,T2,T3,T4and CD4+higher than that of the control group(P<0.05);the2group CD8+had no obvious changes in T1,T2,T3,T4(P>0.05);observation group CD4+/CD8+decreased gradually in T1,T2,were lower than T0(P<0.05),T3,T4returned to T0(P>0.05),the observation group T1,T2CD4+/CD8+was higher than the control group(P<0.05).Conclusion:epidural block combined with intravenous anesthesia for breast cancer radical mastectomy can effectively relieve the stress and inflammatory reaction,alleviate the immunosuppression,and help to restore the postoperative immune function

作者姚远武永生朱红霞苏心镜 YAO Yuan;WU Yong sheng;ZHU Hong xia;SU Xin jing(Department of Anesthesiology, the Second Affiliated Hospital of Hebei North University, 075100)

机构地区河北北方学院附属第二医院麻醉科

出处《海南医学院学报》 CAS 2017年第18期2562-2565,2569,共5页 Journal of Hainan Medical University

基金张家口市科学技术进步项目(1321054D)~~

关键词全凭静脉麻醉硬膜外阻滞复合静脉全麻乳腺癌根治术应激反应 T淋巴细胞亚群 Total intravenous anesthesia Epidural block Combined intravenous general anesthesia Radical mastectomy Stress response T lymphocyte subsets

分类号 R737.9 [医药卫生—肿瘤]