摘要
目的原发性肝癌发生率较高,临床上多以手术治疗为主,但是患者手术过程中选择何种麻醉方法存在争议。本研究主要探讨全麻加胸椎旁阻滞在原发性肝癌患者中的应用及对机体免疫、肿瘤标志物的影响。方法选择西南医科大学附属医院2015-08-01-2017-06-30收治原发性肝癌手术患者40例为研究对象,根据麻醉方案不同分为对照组(n=20)和观察组(n=20)。对照组采用静脉全身麻醉,观察组在对照组基础上联合胸椎旁神经阻滞麻醉。采用流式细胞计数仪测定患者术前、术后7d外周血T淋巴细胞亚群水平,电化学发光法测定甲胎蛋白(AFP)、癌胚抗原(CEA)、铁蛋白(FERR)、糖类抗原199(CA199)和糖类抗原724(CA724)水平。采用直观模拟量表(visual analogue scales,VAS)对两组手术前、后不同时间点疼痛进行评估,比较两组麻醉效果及对机体免、肿瘤标志物的影响。结果观察组术后7d,CD4+和CD8+值均高于对照组,P<0.05;CD4+/CD8+值低于对照组,P<0.05。观察组术后不同时间点疼痛评分均低于对照组,P<0.05。两组手术前AFP、CEA、FERR、CA199及CA724水平比较差异无统计学意义,P>0.05;观察组手术后7d,AFP、CEA、FERR、CA199及CA724水平均低于对照组,P<0.05。观察组并发症发生率低于对照组,差异有统计学意义,P<0.05。结论全麻联合胸椎旁阻滞对原发性肝癌患者应用效果理想,有助于改善患者术后免疫及肿瘤标志物,减轻患者疼痛,值得临床推广应用。
OBJECTIVE The incidence of primary liver cancer is high, and the most of them are mainly surgical treatment. However, it is controversial to choose the anesthesia method during the operation. This study focused on the application of general anesthesia plus thoracic paravertebral block in patients with primary liver cancer and its impact on immune and tumor markers. METHODS Forty patients with primary hepatocellular carcinoma admitted to our hospital from August 2015 to June 2017 were randomly divided into control group （n=20） and observation group （n=20）. The control group was treated with intravenous general anesthesia. The observation group was anesthetized with thoraco para-vertebral nerve tissue on the basis of the control group. The levels of T lymphocyte subsets in peripheral blood pre-operation and 7 days after operation were measured by flow cytometry. The levels of T lymphocyte subsets in peripheral blood were measured by electrochemiluminescence（AFP）, carcinoembryonic antigen（CEA）, ferritin（FERR）, carbohydrate an tigen 199（CA199）, and carbohydrate antigen 724（CA724） were measured. The visual analog scale（VAS） was used before and after pain at different time points to assess the effects of anesthesia and tumor indicators in the two groups. RESULTS The ratio of CD4＋ and CD8＋ in the observation group at 7 days after operation was significantly higher than that in the control group （P〈0.05）. The ratio of CD4＋/CD84 in the observation group at 7 days after operation was lower than that in the control group （P〈0.05）. The AFP, CEA, FERR, CA199 and CA724 levels in the two groups had no significant difference before operation （P〉0.05）. The AFP, CEA, FERR, CA199 and CA724 levels were lower than that of the control group （P〈0.05）. The incidence of complications in the observation group was lower than that in the control group （P〈0.05）. CONCLUSIONS The combined effect of general anesthesia and thoracic paravertebral block in patients with primary li
作者
王明全
周军
WANG Ming quan, ZHOU Jun(Department of Anesthesiology, Affiliated Hospital of Southwest Medical University ,Luzhou 646000, P. R. Chin)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2018年第16期1174-1177,共4页
Chinese Journal of Cancer Prevention and Treatment
关键词
原发性肝癌
全麻
胸椎旁阻滞
机体免疫
肿瘤标志物
直观模拟量表
primary liver cancer
general anesthesia
thoracic paravertebral block
body immunity
tumor markers
visual analogue scale
