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不同麻醉和镇痛方法对食管癌手术患者细胞免疫功能和应激激素水平的影响。

Effects of Different Anesthetic and Analgesic Methods on Cellular Immune Function and Stress Hormone Levels in Patients Undergoing Esophageal Cancer Surgery.

机构信息

Department of Emergency, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China.

Department of Neurology, The People's Hospital of Leshan, Leshan 614000, Sichuan, China.

出版信息

J Healthc Eng. 2022 Mar 12;2022:4752609. doi: 10.1155/2022/4752609. eCollection 2022.

Abstract

The change of perioperative immune function in patients with esophageal cancer is mainly caused by the joint action of surgical trauma and anesthesia. In our study, we aimed to investigate the effects of different anesthetic methods on the changes of T lymphocyte subsets and cytokines in peripheral blood of patients with esophageal cancer surgery. 50 patients with esophageal cancer were divided into the study group and the control group. Among them, the patients in the control group chose intravenous anesthesia and received self-controlled intravenous analgesia after surgery. Patients in the study group chose thoracic epidural anesthesia combined with general anesthesia, undergoing self-controlled epidural analgesia after surgery; serum interleukin-2 (IL-2) and soluble interleukin-2 receptor (sIL-2R) were measured by ELISA. Serum stress hormones GH and sIL-8 were measured by radioimmunoassay. Both groups of patients achieved significant postoperative analgesia, but the VAS score in the study group at the T2-T4 time point was lower than that in the control group. The serum GH concentration in the study group increased at T1 and reached its highest peak at T2, then decreased. The serum IL-8 concentration of the two groups showed a downward trend from T1 to T4. Thoracic epidural anesthesia combined with general anesthesia for postoperative epidural analgesia can relieve the degree of cellular immunosuppression during and after surgery. Moreover, the thoracic epidural block combined with general anesthesia for esophageal cancer surgery and epidural analgesia after surgery for patients are anesthetic and analgesic methods with clinically significant effects. Our research results have a positive effect on the promotion of postoperative rehabilitation in patients with malignant cell tumors.

摘要

食管癌患者围手术期免疫功能的变化主要是由手术创伤和麻醉的共同作用引起的。在我们的研究中,我们旨在探讨不同麻醉方法对食管癌手术患者外周血 T 淋巴细胞亚群和细胞因子变化的影响。50 例食管癌患者分为研究组和对照组。其中,对照组患者选择静脉麻醉,术后接受自控静脉镇痛;研究组患者选择胸段硬膜外麻醉联合全身麻醉,术后行自控硬膜外镇痛;采用 ELISA 法检测血清白细胞介素-2(IL-2)和可溶性白细胞介素-2 受体(sIL-2R),放射免疫法检测血清生长激素(GH)和可溶性白细胞介素-8(sIL-8)。两组患者均获得良好的术后镇痛效果,但研究组 T2-T4 时间点的 VAS 评分低于对照组。研究组血清 GH 浓度在 T1 时升高,在 T2 时达到最高峰值,然后下降。两组血清 IL-8 浓度从 T1 到 T4 呈下降趋势。胸段硬膜外麻醉联合全身麻醉用于术后硬膜外镇痛,可减轻手术期间和手术后细胞免疫抑制的程度。此外,对于接受恶性细胞肿瘤治疗的患者,胸段硬膜外阻滞联合全身麻醉用于食管癌手术和术后硬膜外镇痛是一种具有临床意义的麻醉和镇痛方法。我们的研究结果对促进恶性肿瘤患者术后康复具有积极意义。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1fa1/8934230/9c1e101e3956/JHE2022-4752609.001.jpg

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