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目的:探讨不同麻醉镇痛方法对乳腺癌根治术患者免疫功能与应激水平的影响。方法:选取2015年1月至2016年5月收治的90例乳腺癌患者为研究对象,随机分为研究组和对照组,各45例。研究组采用硬膜外阻滞复合静脉全麻,乳腺癌根治术后行自控硬膜外镇痛。对照组采用全凭静脉麻醉,乳腺癌根治术后行患者自控静脉镇痛。比较两组患者的免疫功能、应激水平及镇痛效果。结果:研究组患者平均动脉压(MAP)及心率(HR)的降低程度显著高于对照组,而MAP及HR的升高程度显著低于对照组(P<0.05);催乳素(PRL)水平在麻醉前30 min(T0)最低,切皮后1 h(T1)最高,术后4、24、48 h(T2、T3、T4)逐渐降低,研究组显著低于对照组(P<0.05);生长激素(GH)水平在T1~T2逐渐升高,T3~T4逐渐降低,研究组显著低于对照组(P<0.05);IL-8水平在T1~T4逐渐降低,研究组显著低于对照组(P<0.05);皮质醇(Cor)水平在T1~T4无显著变化(P>0.05);IFN-γ水平在T1~T4逐渐升高,两组差异无统计学意义(P>0.05);CD3+水平在T1最低,T2~T4逐渐升高,研究组显著高于对照组(P<0.05);CD4+水平逐渐降低,研究组显著高于对照组(P<0.05);CD8+含量在T0~T4无显著变化,组间差异无统计学意义(P>0.05);CD4+/CD8+之值组间差异无统计学意义(P>0.05),但研究组在T1~T4显著高于对照组(P<0.05);研究组NK细胞水平在T0~T4无显著变化,但在T3~T4显著高于对照组(P<0.05)。结论:硬膜外阻滞复合静脉全麻辅以术后自控硬膜外镇痛对乳腺癌根治术患者的镇痛效果较好,对患者免疫功能的抑制较弱,可抑制应激反应,值得推广应用。
Objective: To investigate the effect of different anesthesia analgesia on immune function and stress level in patients with radical mastectomy. Methods: Ninety patients with breast cancer who were treated from January 2015 to May 2016 were selected as study subjects and randomly divided into study group and control group, with 45 cases each. The study group used epidural anesthesia combined with intravenous anesthesia and controlled radical epidural analgesia after radical mastectomy. The control group with full intravenous anesthesia, patients with controlled self-controlled intravenous analgesia after radical mastectomy. The immune function, stress level and analgesic effect of the two groups were compared. Results: The decrease of mean arterial pressure (MAP) and heart rate (HR) in the study group was significantly higher than that in the control group, while MAP and HR were significantly lower than those in the control group (P <0.05). The levels of prolactin (PRL) (T0) before anesthesia, 1 hour after skin incision (T1), and gradually decreased after 4, 24 and 48 hours (T2, T3 and T4), the study group was significantly lower than the control group (P <0.05) (P <0.05). The level of IL-8 gradually decreased from T1 to T2, and the level of T3 to T4 decreased gradually in study group (P <0.05) (P <0.05). There was no significant change in the level of Cortisol between T1 and T4 (P> 0.05). The level of IFN-γ increased gradually from T1 to T4, there was no significant difference between the two groups (P> 0.05) (P <0.05). The level of CD3 + in T 1 was the lowest, the level of T 2 ~T 4 increased gradually in study group, and the level of CD 3 + in study group was significantly higher than that in control group (P> 0.05). However, there was no significant difference between the two groups (P> 0.05), but there was no significant difference between the two groups (P> 0.05) P <0.05). The level of NK cells in study group had no significant change from T0 to T4, but was significantly higher in T3 ~ T4 than that in control group (P <0 .05). Conclusions: Combined epidural anesthesia with intravenous anesthesia supplemented with postoperative epidural analgesia has a better analgesic effect on patients with radical mastectomy and less inhibition of immune function, which can inhibit the stress response, which is worth Promote the application.