标题：全麻复合硬膜外麻醉联合术后硬膜外镇痛对胃癌患者应激状况及免疫功能的影响

      作者：张秋丽，郑子豪    深圳市人民医院麻醉科深圳市麻醉医学工程研究中心，广东 深圳 518020

      卷次： 2019年30卷19期

      【摘要】 目的 探究全麻复合硬膜外麻醉联合术后硬膜外镇痛对胃癌患者应激状况及免疫功能的影响，为临床提供参考依据。方法 选择2016年3月到2018年9月在深圳市人民医院进行胃癌根治术患者106例为研究对象，按照随机数表法将患者分为对照组和观察组，每组53例。对照组实施全麻联合术后静脉镇痛，观察组实施全麻复合硬膜外麻醉联合术后硬膜外镇痛。比较两组患者的麻醉前及术后36 h的应激指标(肾上腺素、去甲肾上腺素、皮质醇、血糖)、免疫功能水平[T淋巴亚群(CD3+、CD4+、CD4+/CD8+)]以及呼吸道感染率。结果 术后36 h，观察组和对照组患者的肾上腺素[(43.71±10.27) μg/L vs (59.62±14.08) μg/L]、去甲肾上腺素[(232.28±98.82) μg/L vs (301.46±112.75) μg/L]、皮质醇[(0.70±0.24) nmol/L vs (0.82±0.31) nmol/L]及血糖[(5.78±1.59) nmol/L vs (7.74±1.53) nmol/L]水平比较，观察组明显低于对照组，差异均有统计学意义(P<0.05)；术后 36 h，观察组和对照组患者的CD3+ [(59.06±7.03)% vs (52.37±6.28)%]、CD4+ [(39.04±6.17)% vs (35.15±5.82)%]以及CD4+/CD8+ (1.64±0.26 vs 1.42±0.41)水平比较，观察组明显高于对照组，差异均有统计学意义(P<0.05)；观察组患者的呼吸道感染率为5.66%，明显低于对照组的22.64%，差异具有统计学意义(P<0.05)。结论 全麻复合硬膜外麻醉联合术后硬膜外镇痛能明显降低胃癌患者应激反应，减轻免疫功能的抑制，且能明显降低呼吸道感染率，值得临床推广应用。
      【关键词】 胃癌；全麻复合硬膜外麻醉；硬膜外镇痛；应激水平；免疫功能；呼吸道感染
      【中图分类号】 R735.2 【文献标识码】 A 【文章编号】 1003—6350（2019）19—2500—04

Effect of epidural anesthesia under general anesthesia combined with postoperative epidural analgesia on stressand immune function in patients with gastric cancer.
ZHANG Qiu-li, ZHENG Zi-hao. Department of Anesthesiology,Shenzhen People's Hospital (Shenzhen Center for Anesthesiology Medical Engineering), Shenzhen 518020, Guangdong,CHINA
【Abstract】 Objective To investigate the effects of epidural anesthesia under general anesthesia combined com-bined with postoperative epidural analgesia on stress status and immune function in patients with gastric cancer, and toprovide reference for clinical practice. Methods A total of 106 patients with gastric cancer, who underwent radical gas-trectomy in Shenzhen People's Hospital from March 2016 to September 2018, were enrolled and divided into the controlgroup and observation group according to random number table method, with 53 cases in each group. The controlgroup received general anesthesia combined with postoperative intravenous analgesia, and the observation group re-ceived epidural anesthesia under general anesthesia combined with postoperative epidural analgesia. The stress indica-tors (adrenaline, noradrenaline, cortisol, blood sugar), immune function (T lymphocyte subsets [CD3 + , CD4 + , CD4 +/CD8+]) before and 36 hours after anesthesia, and respiratory tract infection rate were compared and analyzed betweenthe two groups. Results At 36 hours after surgery, epinephrine, norepinephrine, cortex alcohol, blood glucose in the ob-servation group were (43.71±10.27) μg/L, (232.28±98.82) μg/L, (0.70±0.24) nmol/L, (5.78±1.59) nmol/L, respectively,which were significantly lower than corresponding (59.62±14.08) μg/L, (301.46±112.75) μg/L, (0.82±0.31) nmol/L,(7.74±1.53) nmol/L in the control group (all P<0.05); CD3+, CD4+, CD4+/CD8+ in the observation group were (59.06±7.03)%, (39.04±6.17)%, (1.64±0.26), respectively, which were significantly higher than corresponding (52.37±6.28)%,(35.15±5.82)%, (1.42±0.41) in the control group (all P<0.05); the respiratory infection rate of the observation group was5.66%, which was significantly lower than 22.64% of the control group (P<0.05). Conclusion Epidural anesthesia un-der general anesthesia combined with postoperative epidural analgesia can not only significantly reduce the stress re-sponse of gastric cancer patients, alleviate the inhibition of immune function, but also can significantly reduce the respi-ratory infection rate, which is worthy of clinical application and promotion.
      【Key words】 Gastric cancer; Epidural anesthesia under general anesthesia; Epidural analgesia; Stress level; Im-mune function; Respiratory infection