摘要
目的探讨依托咪酯联合腹横肌平面阻滞(transversus abdominis plane block,TAPB)对全子宫切除术后患者血清炎性因子及免疫功能指标的影响。方法本研究纳入2020年1月至2023年1月接受经腹全子宫切除术的86例患者,根据随机数字表法分为A组(44例)与B组(42例)。A组实施全身麻醉(丙泊酚进行麻醉维持)+TAPB麻醉,B组实施全身麻醉(丙泊酚复合依托咪酯进行麻醉维持)+TAPB麻醉。观察两组不同时点心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)变化,比较两组麻醉前、术后24 h血清相关因子[白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]、免疫功能指标(T淋巴细胞亚群CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)),统计两组麻醉后并发症情况。结果两组患者HR、MAP在T1、T2时较T0时刻逐渐升高,T3、T4时较T2时逐渐回落。术后24 h两组患者血清IL-6、TNF-α较麻醉前升高,B组IL-6、TNF-α分别为(261.17±33.67)、(12.37±2.57)ng/L,均低于A组(287.89±45.71)、(16.46±3.78)ng/L(P<0.05)。术后24 h两组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)较麻醉前降低,B组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)为(65.26±4.67)%、(27.83±2.59)%、1.48±0.35,均高于A组的(62.17±3.85)%、(26.25±2.16)%、1.32±0.21(P<0.05)。两组麻醉后并发症总发生率比较,A组13.64%,B组7.21%,差异无统计学意义(P>0.05)。结论经腹全子宫切除术中应用依托咪酯联合TAPB麻醉能抑制手术创伤引起的炎症反应,维持患者术后免疫功能稳定,且不会增加对患者血流动力学的影响,未增加麻醉后并发症的发生,安全性好。
Objective To investigate the effect of etomidate combined with transversus abdominis plane block(TAPB)on serum inflammatory factors and immune function indexes in patients after total hysterectomy.Methods The study included 86 patients who underwent transabdominal total hysterectomy from Jan.2020 to Jan.2023.They were divided into group A(44 cases)and group B(42 cases)according to the random number table method.Group A received general anesthesia(propofol for anesthesia maintenance)+TAPB anesthesia,and group B received general anesthesia(propofol combined with etomidate for anesthesia maintenance)+TAPB anesthesia.The changes of heart rate(HR)and mean arterial pressure(MAP)at different time points were observed in the two groups.The serum related factors[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]and immune function indexes(T lymphocyte subsets CD3^(+),CD4^(+),CD4^(+)/CD8^(+))were compared between the two groups before anesthesia and 24 h after operation.The complications of the two groups after anesthesia were counted.Results HR and MAP of the two groups were gradually increased at T1 and T2 compared with those at T0,and gradually decreased at T3 and T4 compared with those at T2.The serum levels of IL-6 and TNF-αin the two groups at 24 h after operation were higher than those before anesthesia.The levels of IL-6 and TNF-αin group B were(261.17±33.67)ng/L and(12.37±2.57)ng/L,lower than those in group A(287.89±45.71)ng/L and(16.46±3.78)ng/L(P<0.05).The levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the two groups were lower than those before anesthesia.The levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in group B were(65.26±4.67)%,(27.83±2.59)% and(1.48±0.35),higher than those in group A(62.17±3.85)%,(26.25±2.16)% and(1.32±0.21)(P<0.05).There was no significant difference in the total incidence of complications after anesthesia between the two groups(13.64% in group A and 7.21% in group B)(P>0.05).Conclusions The application of etomidate combined with TAPB anesthesia in total abdominal hysterecto
作者
薛玉荣
张景超
张祥飞
Xue Yurong;Zhang Jingchao;Zhang Xiangfei(Department of Anesthesiology,Suzhou First People’s Hospital,Suzhou 234000,China)
出处
《中华内分泌外科杂志》
CAS
2023年第6期706-710,共5页
Chinese Journal of Endocrine Surgery
基金
安徽高校自然科学研究项目(KJ2021A1570)。
关键词
经腹全子宫切除术
腹横肌平面阻滞
依托咪酯
血清炎性因子
免疫功能
Transabdominal hysterectomy
Transversus abdominis plane block
Etomidate
Serum inflammatory factors
Immune function
