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目的探讨不同麻醉方法对肺癌根治术患者应激反应及免疫功能的影响。方法选取2014年2月至2016年2月间西安医学院第二附属医院收治的84例行肺癌根治术的患者,采用随机数字表法分为观察组与对照组,每组42例。观察组患者给予静脉复合硬膜外麻醉,对照组患者给予单纯静脉麻醉,对比两组患者麻醉前(T0)、麻醉即刻(T1)、术毕(T2)、术后24h(T3)和术后72h(T4)等时间点,外周血血浆皮质醇(Cor)、血管紧张素-Ⅱ(A-Ⅱ)、血清白细胞介素-2(IL-2)、白细胞介素-10(IL-10)水平变化情况及CD3~+、CD4~+、CD4~+CD25~+、CD4~+/CD8~+比值改变情况。结果给予不同麻醉至术毕,两组患者血清Cor和IL-2水平均明显降低,A-Ⅱ和IL-10水平则较T0时点明显升高,差异均有统计学意义(均P<0.05)。T3时点,观察组患者Cor、IL-2、IL-10及A-Ⅱ水平均趋于术前水平,但差异有统计学意义(P<0.05)。对照组患者Cor、IL-2、IL-10和A-Ⅱ水平至T4时点远未恢复至术前水平,差异均有统计学意义(均P<0.05)。两组患者T1、T2时点CD3~+、CD4~+、CD4~+CD25~+和CD4~+/CD8~+比值均明显低于T0时点水平,且观察组患者各比值均较同期对照组水平明显偏高,差异均有统计学意义(均P<0.05)。T3时点,观察组患者CD3~+、CD4~+、CD4~+CD25~+和CD4~+/CD8~+比值明显升高近术前水平,且较同期对照组明显偏高,差异均有统计学意义(均P<0.05)。对照组患者至T4时点各免疫指标水平开始升高,较T0时点差异有统计学意义(P<0.05)。结论静脉复合硬膜外麻醉相较于单纯静脉麻醉能明显减轻肺癌根治术对肺癌患者应激状态下的机体反应,使患者保持相对稳定的免疫功能。
Objective To investigate the effects of different anesthesia on stress response and immune function in patients with lung cancer undergoing radical operation. Methods Eighty-four patients undergoing radical surgery for lung cancer who were admitted to the Second Affiliated Hospital of Xi’an Medical College between February 2014 and February 2016 were randomly divided into observation group and control group with 42 cases in each group. Patients in the observation group were given intravenous combined epidural anesthesia, while those in the control group were given intravenous anesthesia. T0, T1, T2, T3 and postoperative (Cor), angiotensin-Ⅱ (A-Ⅱ), serum interleukin-2 (IL-2), interleukin-10 (IL-10) Level changes and the changes of CD3 ~ +, CD4 ~ +, CD4 ~ + CD25 ~ +, CD4 ~ + / CD8 ~ + ratio. Results The levels of serum Cor and IL-2 in the two groups were significantly decreased, and the levels of A-II and IL-10 were significantly higher than those at the time of T0 (all P <0.05 ). At T3, the levels of Cor, IL-2, IL-10 and A-Ⅱ in the observation group tended to be preoperative, but the difference was statistically significant (P <0.05). The levels of Cor, IL-2, IL-10 and A-Ⅱ in patients in control group were far from the preoperative level until T4, the difference was statistically significant (all P <0.05). The ratios of CD3 ~ +, CD4 ~ +, CD4 ~ + CD25 ~ + and CD4 ~ + / CD8 ~ + at T1 and T2 were significantly lower in both groups than those in T0 group The level of the group was significantly higher, the difference was statistically significant (P <0.05). At T3, the ratio of CD3 ~ +, CD4 ~ +, CD4 ~ + CD25 ~ + and CD4 ~ + / CD8 ~ + in the observation group was significantly higher than that in the control group Statistical significance (all P <0.05). In the control group, the level of each immune index began to increase at T4, which was significantly different from that at T0 (P <0.05). Conclusions Compared with simple intravenous anesthesia, intravenous combined epidural anesthesia can significantly reduce the response of lung cancer patients to the response to lung cancer under stress, and keep the patients relatively stable immune function.