摘要
目的:观察全身麻醉(全麻)复合硬膜外麻醉对肌层浸润性膀胱癌(MIBC)患者术中心血管应激反应及术后血清T淋巴细胞亚群水平的影响。方法:在联勤保障部队第九八八医院手术治疗的MIBC患者92例,采用随机数字表法分为对照组(46例)和研究组(46例),两组均行根治性膀胱切除术及双侧盆腔淋巴结清扫术。对照组采用气管插管全麻,研究组采用全麻复合硬膜外麻醉。比较两组麻醉效果、围手术期(手术前、手术开始后10 min、拔管后5 min)心血管应激反应(心率,舒张压,收缩压)、术后恢复情况、不良反应发生情况、手术前后血清T淋巴细胞亚群(CD3^+、CD4^+、CD8^+)水平变化情况及术后切口感染发生率。结果:研究组麻醉效果优于对照组(P <0.05)。手术开始后10min,两组心率均较手术前升高,但研究组低于对照组;两组舒张压均较术前降低,但研究组高于对照组(P <0.05);研究组收缩压低于手术前而对照组高于手术前,研究组收缩压低于对照组(P <0.05)。拔管后5min,研究组心率、舒张压及收缩压恢复至术前水平,对照组与术前比较差异仍有显著性(P <0.05)。两组术后苏醒时间、恢复意识时间及术后拔管时间比较,研究组均短于对照组(P <0.05)。术后3 h,两组血清CD3^+、CD4^+水平低于手术前,但研究组高于对照组(P <0.05)。研究组术后不良反应总发生率[8.70%(4/46例)]低于对照组[23.91%(11/46例)],差异有显著性(P <0.05)。研究组术后切口感染发生率[4.35%(2/46例)]低于对照组[17.39%(8/46例)],差异有显著性(P <0.05)。结论:MIBC患者在根治性膀胱切除术及双侧盆腔淋巴结清扫术治疗中,采用全麻复合硬膜外麻醉可有效降低心血管应激反应,且麻醉效果显著,麻醉不良反应发生率低,能有效缩短患者术后苏醒时间、拔管时间及恢复意识时间,对患者术后免疫功能影响较小,能有效降低术后切口感染发生率,有助于促进患者康复。
Objective: To observe the effects of general anesthesia combined with epidural anesthesia on int raoperative cardiovascular stress response and postoperative serum T lymphocyte subsets in patients with muscle-invasive bladder cancer (MIBC). Methods: Ninety-two patients with MIBC who underwent surgical treatment in the 988th Hospital of Joint Logistic Support Force were randomly abd equally divided into the control group and study group, with 46 cases in each group. The patients in both groups received radical cystectomy and bilateral pelvic lymphadenectomy (PLND). The control group received general anesthesia with tracheal intubation, and the study group received general anesthesia combined with epidural anesthesia. The anesthetic effects, cardiovascular stress (heart rate, diastolic blood pressure, systolic blood pressure) in perioperative period (before surgery, 10 minutes after surgery, 5 minutes after extubation), postoperative recovery, adverse reactions, serum T lymphocyte (CD3^+, CD4^+, CD8^+) before and after surgery, and the incidence of postoperative incisional wound infection were compared. Results: The anesthetic effect of the study group was better than that of the control group (P<0.05). The heart rate of the study group was lower than that of the control group 10 minutes later of the operation beginning, while they were higher than those before operation in both groups. The diastolic blood pressure in the study group was higher than those in the control group 10 minutes later of the operation beginning, and they were lower than those before operation in both two groups (P<0.05). The systolic blood pressure in the study group was lower but it was higher in the control group 10 minutes later of the operation beginning than those before operation, and it was lower in the study group than that in the control group 10 minutes later of the operation beginning. Five minutes after extubation, the heart rate, diastolic blood pressure and systolic blood pressure of the study group returned to the preoperative level, while there was still significant difference between the control group and preoperative group (P<0. 05). The time of awakening, consciousness recovery and postoperative extubation were shorter in the study group than in the control group (P<0.05). At 3 hours after operation, the serum CD3^+ and CD4^+ levels in the two groups were lower than those before surgery, but they were higher in the study group than the control group (P<0.05). The total incidence of postoperative adverse reactions in the study group [8.70%(4/46 cases)] was lower than that in the control group [23.91%(11/46 cases)], and the difference was significant (P<0.05). The incidence of postoperative incision infection in the study group [4.35%(2/46 cases)] was lower than that in the control group [17.39%(8/46 cases)], and the difference was significant (P<0.05). Conclusions: In MIBC, general anesthesia combined with epidural anesthesia can effectively reduce cardiovascular stress in radical cystectomy and bilateral PLND, and the anesthetic effect is significant with low incidence rate of adverse reactions. It can effectively shorten the postoperative time for awakening, extubation and consciousness recovery of the patient, and has less influence on the postoperative immune function, which can effectively reduce the incidence of postoperative incision infec tion and help to promote the recovery of the patient.
作者
钟成跃
魏海利
周辉
Zhong Chengyue;Wei Haili;Zhou Hui(Department of Anesthesiologist, The 988th Hospital of Joint Logistic Support Force, Zhengzhou, Henan 450042, China)
出处
《感染．炎症．修复》
2019年第2期96-100,共5页
Infection Inflammation Repair
关键词
麻醉
肌层浸润性膀胱癌
心血管应激反应
T淋巴细胞亚群
Muscle-invasive bladder cancer
Anesthesia
Cardiovascular stress response
T lymphocyte subsets
