摘要
目的探究不同麻醉方法对腹腔镜疝修补术患者免疫功能的影响,以找出最佳的麻醉方式。方法前瞻性选择2015年1月至2017年12月在中国人民解放军第254医院行腹腔镜疝修补手术的140例患者,采用随机数表法将其均分为观察组和对照组,每组70例,观察组予以全凭静脉麻醉进行维持,对照组以吸入方式进行维持,在麻醉前、手术结束时、术后1 d、术后3 d早晨7～8点分别检测两组患者T淋巴细胞亚群及炎症因子水平,并比较两组患者的不良反应情况。结果两组患者的手术时间、麻醉时间及拔管时间比较差异均无统计学意义(P>0.05);手术结束时和术后1 d,两组患者的CD3^+、CD4^+T细胞、CD4^+/CD8^+均较麻醉前明显降低,术后3 d,两组患者的CD3^+、CD4^+T细胞较麻醉前也明显降低,差异均具有统计学意义(P<0.05);术后3 d,观察组患者的CD3^+、CD4^+T细胞水平分别为(60.18±11.38)%和(35.08±9.17)%,明显高于对照组的(54.88±11.78)%和(28.78±8.63)%,差异均具有统计学意义(P<0.05);两组患者术后3 d的白细胞介素-6 (IL-6)和C-反应蛋白(CRP)水平分别为(61.13±12.35) pg/mL和(75.12±10.68)μg/mL,均明显低于对照组的(66.11±12.34) pg/mL和(80.12±13.85)μg/mL,差异均具有统计学意义(P<0.05);对照组患者的不良反应发生率为27.14%,明显高于观察组的12.86%,差异具有统计学意义(P<0.05)。结论全凭静脉麻醉对腹腔镜疝修补术患者免疫功能的影响较小,能有效控制炎症和应激反应,且不良反应发生率低,适合推广使用。
Objective To explore the effects of different anesthesia methods on immune function in patients undergoing laparoscopic hernia repair to find the best anesthesia. Methods A total of 140 patients who underwent laparoscopic hernia repair at the No.254 Hospital of Chinese People’s Liberation Army from January 2015 to December 2017 were randomly divided into observation group and control group, with 70 cases in each group. The observation group was maintained by intravenous anesthesia, and the control group was maintained by inhalation. The levels of T lymphocyte subgroups and inflammatory factors were detected before anesthesia, at the end of operation, and at7:00 am to 8:00 am on day and day 3 after the operation. The adverse reactions of the two groups of patients were compared. Results The differences in operation time, anesthesia time and extubation time between the two groups were statistically significant(P>0.05). At the end of surgery and day 1 after surgery, the levels of CD3^+, CD4^+T cells and CD4^+/CD8^+ratio in the two groups were significantly lower than those before anesthesia. At days 3 after operation,the levels of CD3^+and CD4^+T cells in the two groups were significantly lower than those before anesthesia(P<0.05).At days 3 after operation, the levels of CD3^+and CD4^+T cells in the observation group were(60.18 ± 11.38)% and(35.08 ± 9.17)%, respectively, which were significantly higher than(54.88 ± 11.78)% and(28.78 ± 8.63)% in the control group(P<0.05); and the levels of interleukin-6(IL-6) and C-reactive protein(CRP) in the observation group were(61.13±12.35) pg/mL and(75.12±10.68) μg/m L, respectively, which were significantly lower than(66.11±12.34) pg/mL and(80.12 ± 13.85) μ g/mL in the control group(P<0.05). The incidence of adverse reactions in the control group was27.14%, which was significantly higher than 12.68% in the observation group, and the difference was statistically significant(P<0.05). Conclusion Total intravenous anesthesia has little effect on the immune function of patients undergoing laparoscopic hernia repair, which can effectively control inflammation and stress response, and the incidence of adverse reactions is low. Then the method is suitable for popularization.
作者
王亚迪
孙家潭
景莹莹
WANG Ya-di;SUN Jia-tan;JING Ying-ying(Department of Anesthesiology,the No.254Hospital of Chinese People's Liberation Army,Tianjin 300142,CHINA)
出处
《海南医学》
CAS
2018年第22期3139-3142,共4页
Hainan Medical Journal
关键词
全凭静脉麻醉
腹腔镜
疝修补术
免疫功能
Total intravenous anesthesia
Laparoscope
Hernia repair
Immune function
作者简介
通讯作者:景莹莹,E-mail.jingyysd@126.com.
