摘要
目的探讨不同麻醉方法对妇科肿瘤患者围术期T淋巴细胞亚群及血糖的影响。方法拟行麻醉手术治疗的妇科肿瘤患者40例随机分为A组(n=20)和B组(n=20)。其中A组在单纯全麻下进行手术治疗,B组在全麻复合硬膜外阻滞情况下进行手术治疗。比较两组手术情况。分别于麻醉前(T1),全麻诱导后(T2),术后1 h(T3),术后24 h(T4),术后48 h(T5),检测各时段外周血T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)、血糖(GLU)。并统计比较两组不良反应的发生率和预后状况。分析两组患者围术期T淋巴细胞亚群及血糖水平与其预后状况的关系。结果两组手术时间、出血量、术前和术后48 h疼痛(VAS)评分等手术情况比较差异无统计学意义(P>0.05)。相对于T1,两组T2的CD3+、CD4+、CD8+、CD4+/CD8+均出现不同程度的降低,随后T3、T4、T5的CD3+、CD4+、CD8+、CD4+/CD8+均逐渐升高,且B组T2、T3、T4、T5的CD3+、CD4+、CD8+、CD4+/CD8+均高于A组(P<0.05)。相对于T1,两组T2、T3、T4、T5的的GLU均较高,且B组T2、T3、T4、T5的GLU均低于A组(P<0.05)。两组恶心、呕吐、伤口感染、皮肤搔痒、尿潴留等不良反应的发生率和复发率比较无明显差异(P>0.05)。两组患者围术期T淋巴细胞亚群及血糖水平与其复发状况均相关(P<0.05)。结论全麻复合硬膜外阻滞能减轻T淋巴细胞亚群的抑制且其对血糖波动的影响较小,有助于早期恢复免疫功能和康复。
Objective To investigate the effects of different anesthesia methods on T lymphocyte subsets and blood sugar in patients with gynecological tumors during perioperative period.Methods A total of 40 patients with gynecologic tumors scheduled for anesthesia surgery were randomly divided into group A(n=20)and group B(n=20).Group A underwent surgery by general anesthesia alone,while group B underwent surgery by general anesthesia combined with epidural block.The operation results of the 2 groups were compared.T lymphocyte subsets(CD3+,CD4+,CD8+,CD4+/CD8+),blood glucose(GLU)were measured before anesthesia(T1),after general anesthesia induction(T2),1 hour after surgery(T3),24 hours after surgery(T4),and 48 hours after surgery(T5).The rate of adverse reactions and prognosis were compared between the two groups.The relationship between perioperative T lymphocyte subsets and blood glucose levels with prognosis in two groups were analyzed.Results There was no significant difference in operation time,bleeding volume,VAS scoresin 48-hour before and after surgery between the two groups(P>0.05).Compared with those of T1,the levels of CD3+,CD4+,CD8+,CD4+/CD8+in T2 in both groups decreased in varying degrees,and then T3,T4,T5 CD3+,CD4+,CD8+,CD4+/CD8+increased gradually.The levels of CD3+,CD4+,CD8+,CD4+/CD8+in group B were higher than those in group A(P<0.05).Compared with those of T1,the GLUs of T2,T3,T4 and T5 in both groups increased,and the GLUs of T2,T3,T4 and T5 in group B were lower than those in group A(P<0.05).There was no significant difference in the rate of nausea,vomiting,respiratory depression,skin itching,urinary retention and recurrence rate between the two groups(P>0.05).Perioperative T lymphocyte subsets and blood glucose levels in both groups were correlated with recurrence conditions(P<0.05).Conclusion General anesthesia combined with epidural anesthesia could reduce the inhibition of T lymphocyte subsetsand its effect on blood sugar fluctuation is small,which is helpful to early recovery of immune function and rehabilitation.
作者
胡钦擎
周吾钊
林明河
张晓佳
周赞得
HU Qinqing;ZHOU Wuzhao;LIN Minghe;ZHANG Xiaojia;ZHOU Zande(Department of Anesthesiology,Shantou Second People′s Hospital,Shantou 515000,China)
出处
《实用医学杂志》
CAS
北大核心
2020年第5期645-649,共5页
The Journal of Practical Medicine
基金
汕头市科技计划医疗卫生类别项目(编号:170821231930856)。
关键词
麻醉方法
妇科肿瘤
围术期
T淋巴细胞亚群
血糖
anesthesia method
gynecological neoplasms
perioperative period
T lymphocyte subsets
blood sugar
