摘要
目的探讨不同麻醉方式对上腹部手术应激和免疫功能的影响。方法60例择期上腹部手术的患者随机分为3组:硬膜外阻滞组(A组)、单纯全麻组(B组)、硬膜外阻滞加全麻组(C组)。分别于不同时间点抽取外周静脉血,采用高效液相色谱法测定肾上腺素(E)和去甲上腺素(NE)、采用放射免疫分析法测定皮质醇、采用流式细胞仪测定T淋巴细胞亚群及自然杀伤细胞数量。结果:A组和B组的皮质醇在各个时间点有不同程度的升高(P<0.05或P<0.01),C组则无明显变化;3组E、NE各个时间点均显著高于麻醉前(P<0.05或P<0.01),但C组与A、B组比较,E、NE均低于A、B两组(P<0.05或P<0.01);术后3d时,C组E已恢复到麻醉前水平,而A、B组E、NE于术后3d均仍未恢复;三组T淋巴细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+及NK细胞数量均有所下降,术后1d达最低水平,且以B组(全麻组)更为明显,三组术后3d免疫功能基本恢复至术前水平。结论3种麻醉方法均不能完全阻断手术创伤性刺激导致的应激反应,硬膜外阻滞复合全麻用于行上腹部手术,应激反应小,有利于维护患者免疫功能稳定。
Objective To compare the effects of three different anesthesia methods on the stress and immune function in upper abdominal surgery. Methods There 60 patients were randomly divided into three groups：epidural anesthesia alone （group A）, general anesthesia alone （group B） and epidural anesthesia combined with general anesthesia （group C）. Peripheral venous blood samples were taken before anesthesia,at lh after operation and on the first and third day afte operation for determination of T-lymphocyte CD3＋ ,CD4＋ ,CD4＋/CD8＋ and CD56＋ by flow cytometer and cortisol by raoimmunoassay, epinephrine,norepinephrine by HPLC. Results Cortisol increased at different time points in group A and B （P〈0.05） and group C remained unchanged. The levels of CD3＋,CD4＋,CD8＋,CD4＋/CD8＋ and CD56＋decreased in three groups. The levels on the third day afte operation were CD3＋,CD4＋,CDs＇,CD4＋/CD8＋ and CD56＋ were returned to the veles before operation in three groups. Conclusions Epidural block combined with general anesthesia is better for upper abdominal surgery, it helps reduce traumatic stimulation produced by surgical operation.
出处
《中国热带医学》
CAS
2009年第9期1770-1771,共2页
China Tropical Medicine
关键词
硬膜外麻醉
全身麻醉
应激
免疫
T淋巴细胞亚群
Epidural anesthesia
General anesthesia
Stress
Immunity
T-lymphocytes subsets
