三种不同麻醉方法对乙状结肠癌根治手术患者C反应蛋白及补体变化的影响

目的 探讨不同麻醉方法对乙状结肠癌根治手术患者C反应蛋白及补体变化的影响.方法 选择2011年5月～2012年12月河池市第一人民医院择期行乙状结肠癌手术的患者60例,ASA Ⅰ～Ⅱ级,随机分为三组,每组各20例,A组为单纯硬膜外麻醉组,B组为静吸复合麻醉组,C组为静吸复合麻醉+硬膜外麻醉组.分别在麻醉诱导前(T1)、手术结束时(T2)、术后24 h(T3)及术后72 h(T4)抽取血样,测定C反应蛋白(CRP)及补体C3、C4水平.结果 与同组内T1时段比较,三组患者C反应蛋白在T3、T4均有不同程度增高(P＜ 0.05),但B、C组增高浓度在正常范围之内;同时段组间比较,A组CRP在T3及T4时较B、C组增高,差异均有统计学意义(P＜0.05).与同组内T1时段比较,三组C3在T2有所降低(P＜0.05),但在T3均能升至麻醉前水平;与其他两组比较,C组C3、C4在T3及T4增高差异有统计学意义(P＜0.05).结论 硬膜外阻滞麻醉+静吸复合麻醉用于乙状结肠癌根治手术患者可明显减轻术中及术后应激反应,有利于补体系统的稳定.

Effect of three different anesthesia methods on the C reactive protein and complement in patients with sigmoid colon cancer radical surgery

Objective To study the effect of different anesthesia methods on the C reactive protein （CRP） and comple- ment in patients with sigmoid colon cancer radical surgery. Methods 60 patients were randomly divided into three groups： epidural anesthesia a lone （group A, n = 20）, vein combined inhalation anesthesia （group B, n = 20）, vein com- bined inhalation anesthesia ＋ epidural anesthesia （group C, n = 20）. CRP and complement in blood serum were de- tected at before induction （T1）, the end of operative procedure （T2）, 24 hour after operation （T3） and 72 hour after opera- tion （T,）. Results Compared to T~, CRP in three groups were significantly higher at T3, T, respectively （P 〈 0.05）, but group B and C increased in a normal rang; compared to other groups at the same time, the extent of CRP in group A were significantly increased at T3, T4 （P 〈 0.05）, while group B, C were not significantly different. Compared to T~, C3 in three groups were significantly decreased at T2 respectively （P 〈 0.05）, but recovered to normal range in 24 hour af- ter operation; compared to the other group; C3, C4 in group C were significantly higher than those in group A and B respectively at T3, T4 （P 〈 0.05）. Conclusion Vein combined inhalation anesthesia ＋ epidural anesthesia can signifi- cantly reduce stress reaction for patients with sigmoid colon cancer radical surgery in intraoperative and postoperative time and can profit to the stability of complement system.