不同麻醉方法对肝癌切除术后患者肿瘤转移因子、C反应蛋白以及T淋巴细胞的影响

目的:观察不同麻醉方法对肝癌切除术后患者肿瘤转移因子、C反应蛋白以及T淋巴细胞的影响，以期找到更适合于肝癌切除手术的麻醉方法。方法:选取我院肝胆外科收治、ASAⅠ-Ⅱ级Child Pugh分类为A级的肝癌患者32例，随机分为两组:静吸复合麻醉组（A组，n=16）和静脉复合麻醉联合胸部硬膜外麻醉组（B组，n=16）。B组于T8-9穿刺置管,注入1%利多卡因5ml确定麻醉平面后,行快速诱导气管内插管,之后每小时硬腹外导管推注1%利多卡因5-7ml,直至术毕。同时输注异丙酚8-10mg/（kg·h）+瑞芬太尼1mg/h+卡肌宁30mg/h维持麻醉深度。A组持续输注异丙酚，间断静注舒芬太尼及卡肌宁,维持麻醉至手术结束。分别在麻醉前（T1）、术毕（T2）、手术后1天（T3）、术后3天（T4）抽取患者静脉血3ml，测定肿瘤转移因子（CK20mRNA）、C反应蛋白（CRP）以及T淋巴细胞亚群（CD3+、CD4+、CD8+）。结果:A、B两组术后1天、术后3天血液CK20mRNA阳性率均比麻醉前低，差异有统计学意义（P＜0.05）；B组术后3天血液CK20mRNA阳性率较A组低，差异有统计学意义（P＜0.05）；A、B两组术后1天、术后3天血液CRP均明显比麻醉前增高，差异有统计学意义（P＜0.05）；B组术后3天血液CRP较A组低，差异有统计学意义（P＜0.05）；与麻醉前相比，A、B两组术毕、术后1天、术后3天CD3+、CD4+及CD4+/CD8+均明显下降，差异有统计学意义（P＜0.05）；B组术后3天CD3+、CD4+及CD4+/CD8+均较A组高，差异有统计学意义（P＜0.05）。结论:静脉复合麻醉联合胸部硬膜外麻醉组能减轻肝癌切除术围手术期应激反应，降低肿瘤转移因子阳性率和较迅速恢复免疫系统的影响,提示静脉复合麻醉联合胸部硬膜外麻醉是肝癌切除术较为合适的麻醉方法，对临床具有指导意义，值得临床推广。

Two different methods of anesthesia for patients with tumor metastasis after resection of liver cancer factor,C-reactive protein and T lymphocyte impact study

Objective:To study the influence of different anesthesia methods on tumor metastasis after resection of liver cancer patients factor,C-reactive protein and T lymphocyte.Methods:32 patients with liver cancer,were randomly divided into two group (group A,n=16) and compound vein anesthesia combined thoracic epidural anesthesia group (group B,n=16),respectively.Before anesthesia (T1),bi (T2),1 day (T3) after surgery,postoperative 3 days (T4) extraction of venous blood in patients with 3ml,determine tumor transfer factor (CK20mRNA),C-reactive protein (CRP) and T lymphocyte subsets (CD3+,CD4+,CD8+).Results:A,B two groups of surgery,postoperative 1 day,3 days after finish the blood CK20mRNA positive rate was lower than before anesthesia,the difference was statistically significant (P＜0.05).3 days after the blood group B CK20mRNA positive rate was lower than those of group A,the difference was statistically significant (P＜0.05).A,B two groups of surgery,postoperative 1 day,3 days after finish blood CRP were significantly higher than before anesthesia,the difference was statistically significant (P＜0.05).Group B 3 days after the blood CRP was lower than those of group A,the difference was statistically significant (P＜0.05).Compared with before anesthesia,A,B two groups of surgery,postoperative 1 day,3 days after finish the CD3+,CD4+ and CD4+/CD8+ were significantly lower,the difference was statistically significant (P＜0.05).Group B after 3 days of CD3+,CD4+ and CD4+/CD8+ were higher than group A,the difference was statistically significant (P＜0.05).Conclusion:Compound vein anesthesia in thoracic epidural anesthesia group,perioperative stress response can reduce liver cancer resection,reduce tumor metastasis factor positive rate and more quickly restore the immune system,the influence of tip compound vein anesthesia combined thoracic epidural anesthesia is suitable anesthesia method,liver resection for clinical guiding significance.