摘要
目的探讨静脉全麻复合硬膜外麻醉(CGEA)及患者自控硬膜外镇痛(PCEA)对食管癌患者术后 T 细胞亚群及循环、呼吸的影响。方法选择60例 ASA Ⅰ或Ⅱ级择期行食管癌根治术的患者,随机均分为三组。A 组行 CGEA 及术后 PCEA,B 组行 CGEA 及术后患者自控静脉镇痛(PCIA),C 组行全凭静脉麻醉及术后 PCIA。分别于麻醉前30 min(T_0)、术后4 h(T_1)、1 d(T_2)、2 d(T_3)、3 d(T_4)、7 d(T_5)取外周静脉血2 ml,用流式细胞仪测定 T 淋巴细胞亚群,并观察各时间点循环、呼吸指标以及疼痛、镇静评分。结果三组患者 T_1～T_3时 CD3^+、CD4^+、CD8^+、CD4^+/CD8^+均明显下降(P<0.05)。B、C 组 RR 在T_1时明显快于 A 组(P<0.05)。T_4时 A 组 T 淋巴细胞亚群恢复至 T_0,B 组和 C 组 T_5时 CD3^+、CD4^+、CD8^+、CD4^+/CD8^+均基本恢复。结论 CGEA 辅以术后PCEA 可改善食管癌患者术后呼吸、循环功能并减轻免疫功能的抑制。
Objective To investigate the effect of total intravenous anesthesia （TIVA） combined epidural anesthesia and postoperative epidural analgesia on cardiopulmonary function and T-lymphocyte subsets in patients undergoing esophagus carcinoma surgery. Methods Sixty ASA Ⅰ or Ⅱ class esophagus carcinoma patients were randomly allocated into three groups with 20 cases each. The patients in group A received combined TIVA-epidural anesthesia and postoperative epidural analgesia. Group B received combined TIVA-epidural anesthesia and postopera＇tive intravenous analgesia（PCIA）. Group C received TIVA and PCIA. Peripheral blood samples were taken before induction of anesthesia（T0 ） ,4 hours after operation（T1 ）and on the first（T2 ）, second（T3 ）, third（T4 ） and seventh（T5 ） postoperative day. T-lymphocyte subsets （CD3^- , CD4 ^＋ , CD8^- , CD4^＋ /CD8^- ） were detected by flow cytometry, and hemodynamics, respiration and the scores of pain and sedation were observed in different time points. Results CD3,CD4,CD8 and CD4/CD8 decreased significantly at T1 and T2 in three groups. Repiratory and cardiovascular function were also depressed at T1 and T2 in three groups. T-subsets recovered on the 3rd postoperative day inthe group A, while group C on the 7th postoperative day. The respiratory and cardiovascular depression was lower than that of group B and C. There was no significant difference in the adverse effects among three groups. Conclusion The perioperative depression of respiration,circulation and immune function can be reduced during combined TIVA epidural anesthesia and postoperative epidural analgesia in patients with carcinoma of esophagus undergoing thoracotomy.
出处
《临床麻醉学杂志》
CAS
CSCD
2008年第9期778-781,共4页
Journal of Clinical Anesthesiology
基金
江苏省卫生厅医学科技发展基金(2007H05)
关键词
硬膜外阻滞
静脉全麻
术后镇痛
食管痈
Epidural block
TIVA
Postoperative analgesia
Esophagus cancer
