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目的:探讨靶控输注静脉麻醉和腰硬联合麻醉对直肠癌根治术患者免疫功能的影响。方法:选择在我院行直肠癌根治术的72例患者,将其分为观察组和对照组各36例,其中观察组给予靶控输注静脉麻醉,对照组采用腰硬联合麻醉,对两组患者手术时间、术中出血量以及免疫球蛋白水平(IgG、IgA、IgM)、血清白介素-6水平(IL-6)、肿瘤坏死因子-a水平(TNF-a)以及T细胞亚群(CD3、CD4)水平进行对比。结果:观察组手术平均时间为(130.5±11.7)min,术中平均出血量为(271.3±37.8)ml,与对照组比较差异均无统计学意义(P>0.05);两组IgG、IgA及IgM,在T1、T2、T3及T4时刻水平比较差异均无统计学意义(P>0.05);两组IL-6、TNF-a、CD3及CD4在麻醉后较T1时均有明显变化,比较差异均有统计学意义(P<0.05),且观察组变化较对照组更为明显,两组比较差异有统计学意义(P<0.05)。结论:靶控输注静脉麻醉和腰硬联合麻醉对直肠癌根治术患者免疫功能均存在抑制作用,且以抑制细胞免疫功能为主,而腰硬联合麻醉抑制作用较低,值得推广应用。
Objective: To investigate the effects of target-controlled infusion of intravenous anesthesia and combined spinal and epidural anesthesia on immune function in patients undergoing radical resection of rectal cancer. Methods: Totally 72 patients undergoing radical resection of rectal cancer in our hospital were divided into observation group and control group, with 36 cases in each group. The observation group received target controlled infusion of intravenous anesthesia, the control group received combined spinal and epidural anesthesia, The operation time, intraoperative blood loss and immunoglobulin levels (IgG, IgA, IgM), serum interleukin-6 (IL-6), tumor necrosis factor-a (TNF-a) and T cell subsets CD3, CD4) levels were compared. Results: The average operation time in the observation group was (130.5 ± 11.7) min and the mean intraoperative blood loss was (271.3 ± 37.8) ml, respectively. There was no significant difference between the two groups (P> 0.05) IgM, there was no significant difference at T1, T2, T3 and T4 (P> 0.05). The levels of IL-6, TNF-a, CD3 and CD4 in both groups were significantly changed after T1 compared with T1 The differences were statistically significant (P <0.05), and the observation group changes more obvious than the control group, the difference between the two groups was statistically significant (P <0.05). CONCLUSION: Targeted controlled infusion of intravenous anesthesia and combined spinal and epidural anesthesia have an inhibitory effect on immune function in patients undergoing radical resection of rectal cancer, and the inhibition of cellular immune function is the predominant, while the inhibition of combined spinal and epidural anesthesia is low, which is worth popularizing and applying.