摘要
目的探讨不同麻醉方案对原发性肝癌患者围术期血流动力学及免疫功能的影响,为原发性肝癌手术患者麻醉方案的选择提供参考。方法选择2015年2月—2017年3月我院收治的原发性肝癌手术患者83例作为研究对象,根据麻醉方案的不同分为全麻组41例和复合组42例,全麻组患者采用静脉全麻,复合组患者采用静脉全麻复合硬膜外麻醉。比较两组患者围术期平均动脉压(MAP)、心率(HR)、血氧饱和度(Sp O2)、收缩压(SBP)的变化,以及术前、术后24 h、术后72 h的免疫功能指标Ig G、Ig A、Ig M、中性粒细胞趋化指数、中性粒细胞黏附率、中性粒细胞吞噬率、中性粒细胞杀菌率变化情况。结果全麻组患者在围术期的MAP、HR、SBP变化幅度明显大于复合组。术后24 h,两组患者Ig G、Ig A、Ig M、中性粒细胞趋化指数、中性粒细胞黏附率、中性粒细胞吞噬率、中性粒细胞杀菌率均较术前降低(P<0.05),复合组患者术后24 h上述免疫功能指标均明显低于全麻组患者(P<0.05);术后72 h两组患者上述免疫功能指标均逐渐恢复至术前水平,与术前比较差异均无统计学意义(P>0.05)。结论麻醉对原发性肝癌患者围术期免疫功能有一定的影响,但影响时间较短,术后72 h患者免疫功能逐渐恢复正常。临床及手术医生应重点关注患者病情,选择对患者生理指标影响较小的麻醉方案,确保患者的麻醉安全。
Objective To compare the effects of different anesthetic procotols on the hemodynamics and immunological function of patients with primary liver cancer during perioperative period.Methods Eighty-three patients with primary liver cancer treated in our hospital from February 2015 to March 2017 were selected as the study subjects,and divided into general anesthesia group(n=41)and combination group(n=42)according to different anesthesia protocols.Patients in general anesthesia group received intravenous anesthesia,whereas those in combination group received intravenous anesthesia combined with epidural anesthesia.We compared physiologicalindexes during perioperative period,including mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(SpO 2),systolic blood pressure(SBP),and indexes of immunological function(IgG,IgA,IgM immune globulin level,neutrophil chemotactic index,the rate of adhesion,phagocytosis rate,sterilization rate,and the percentage of NK cells)before surgery as well as at 24 hours and 72 hours after surgery.Results The changes of MAP,HR and SBP were significantly higher during the perioperative period in general anesthesia group than in combination group.At 24 h after surgery,IgG,IgA,IgM,neutrophil chemotactic index,the rate of adhesion,phagocytosis rate,sterilization rate,and the percentage of NK cells were lower than those prior to surgery(P<0.05),and the above indexes of immune function were significantly lower in combination group than in general anesthesia group(P<0.05).The above indexes of both groups were gradually restored to preoperative level,showing no significant differences between the two groups(P>0.05).Conclusion Different anesthesia methods have certain effects on indexes of immune function,which have a shorter duration.At 72 h after surgery,immunological function in patients with different anesthesia protocols can return to normal.Therefore,physicians should focus on the conditions of patients,and choose anesthesia protocols that minimally change the physiological indexes,thereby ensuring the safety of anesthesia.
作者
高建华
魏智慧
GAO Jian-hua;WEI Zhi-hui(Department of Anesthesiology,Yi County Hospital of Baoding,Baoding,Hebei 074200,China;Department of Anesthesiology,the Second Central Hospital of Baoding,Baoding,Hebei 072750,China)
出处
《临床误诊误治》
2018年第4期56-59,共4页
Clinical Misdiagnosis & Mistherapy
基金
保定市科学技术项目(20174067-2)
关键词
肝肿瘤
麻醉
全身
麻醉
硬膜外
血流动力学
Liver neoplasms
Anesthesia,general
Anesthesia,epidural
Hemodynamics
