全麻联合硬膜外麻对结肠癌手术患者免疫功能的影响

【目的】探讨全身麻醉联合硬膜外麻醉对结肠癌手术患者免疫功能的影响。【方法】结肠癌手术患者160例，按术中麻醉方式不同分为两组，每组各80例，对照组患者行全身麻醉，观察组行硬膜外麻醉联合全身麻醉，比较两组患者麻醉诱导前半小时（T1）、切皮后2 h（T2）、手术结束时（T 3）、手术后 d1（T4）、手术后 d3（T5）体内细胞免疫指标以及白细胞介素6（IL‐6）的水平。【结果】两组患者 CD4＋、CD4＋／CD8＋水平于 T2开始下降，其中对照组 T1时 CD4＋，CD4＋／CD8＋水平显著高于 T 2～ T5时，且差异具有显著性（ P ＜0．05）；观察组患者 CD4＋、CD4＋／CD8＋水平于 T1时显著高于 T3～ T5时（ P ＜0．05）；对照组患者 CD4＋水平于 T4时， CD4＋／CD8＋水平于 T5时显著高于观察组，且差异具有显著性（ P ＜0．05）；两组患者 CD8＋水平、NK 细胞水平于不同时期变化不明显，组间、组内比较差异均无显著性（ P ＞0．05）。 T2时患者 IL‐6水平均开始上升，T1时两组 IL‐6水平显著低于 T2～ T5时，且差异有显著性（ P ＜0．05）；观察组患者 T2～ T4时 IL‐6水平显著低于对照组，且差异具有显著性（ P ＜0．05）。【结论】硬膜外麻醉联合全身麻醉对结肠癌手术患者免疫功能和IL‐6水平影响较单纯全身麻醉小。

Effects of Different Anesthetic Methods on the Immune Function of Patients with Colon Cancer Surgery

Objective] To investigate the effects of general anesthesia and epidural anesthesia on the im‐mune function of patients with colon cancer surgery .[Methods]One hundred and sixty cases of patients with colon cancer surgery were divided according to method of anesthesia in the operation into two groups :control group with 80 cases who had general anesthesia ,observation group with 80 patiens who hadreceived epidural anesthesia combined with general anesthesia .Cellular immunity index and the levels of interleukin 6 (IL‐6) were compared between patients of the two groups at different time points (half an hour before anesthesia in‐duction (T1 ) ,2 hours after incision (T2 ) ,the end of surgery (T3 ) ,1 day after surgery (T 4 ) ,and 3 days (T5 ) after surgery) .[Results]In both groups of patients ,CD4 + and CD4 + /CD8 + levels at T 2 began to de‐cline ;the levels in patients in the control group at T1 were significantly higher than those of T2 through T5 ( P< 0 .05) .Observation group patients'CD4 + ,CD4 + /CD8 + levels at T1 were significantly higher than at T3 ~T5 ,(P < 0 .05) .CD4 + levels in control group patients at T4 is significantly higher than that in observation group patients ,while CD4 + /CD8 + levels at T5 were significantly higher than that of observation group pa‐tients ( P < 0 .05) .CD8 + level of patients in the two groups did not change significantly ,and the levels of NK cells at different periods showed no statistical difference ( P > 0 .05) .At T2 ,the level of IL‐6 began to rise ;levels of IL‐6 at T1 were significantly lower than at T2 ~ T5 for patients of both groups( P < 0 .05) .At T2 through T4 ,levels of IL‐6 in patients of the observation group were significantly lower than those of patients in the control group ( P < 0 .05) .[Conclusion]Compared to general anesthesia alone ,the effect of epidural an‐esthesia combined with general anesthesia on the immune function and IL‐6 levels in colon cancer surgery pa‐tients was relatively smaller .