陈新艳++++++王蕾++++++牛世坤++++++房先杰

[摘要] 目的 觀察并分析不同麻醉方法对妇科手术患者免疫功能的影响。 方法 选取2014年1月～2015年12月在十堰市妇幼保健院进行妇科手术的患者156例为研究对象，根据麻醉方式将所有患者分为三组，A组采用右美托咪定静脉泵注联合七氟烷吸入麻醉，B组采用七氟烷吸入麻醉，C组采用丙泊酚联合舒芬太尼麻醉。观察所有患者麻醉开始前（T0）、术后2 h（T1）、术后6 h（T2）、术后12 h（T3）、术后1 d（T4）、术后3 d（T5）、术后7 d（T6）时的收缩压（SBP）、舒张压（DBP）、心率（HR）、呼吸率（RR）和血氧饱和度（SpO2）外周血T淋巴细胞亚群数量变化情况及炎症细胞因子变化。 结果 A组患者T1、T2、T3时的SBP，T1、T2时的DBP、RR，T1、T6的TNF-α水平，T1～T6的IL-6、IL-8水平，T1时的CD3+水平，T1、T2时的CD4+水平与T0时比较，差异有统计学意义（P < 0.05）。B组患者T1、T2、T3时的SBP，T1、T2时的RR，T1、T2、T5、T6时的TNF-α水平，T1～T6的IL-6、IL-8水平，T1时的CD3+水平，T1、T2、T3时的CD4+水平与T0时比较，差异有统计学意义（P < 0.05）。C组患者T1、T2、T3时的SBP，T1、T4～T6的TNF-α水平，T6时的IL-1β水平，T1～T6的IL-6、IL-8水平，T1时的CD3+、CD4+水平与T0时比较，差异有统计学意义（P < 0.05）。B组患者T1～T6的IL-6水平，T1、T5、T6的IL-8水平，C组患者T5时的TNF-α水平，术后T1～T6的IL-6、IL-8水平与A组同时期比较，差异有统计学意义（P < 0.05）。C组患者术后T1～T6的IL-6、IL-8水平与B组同时期比较，差异有统计学意义（P < 0.05）。 结论 右美托咪定静脉泵注联合七氟烷吸入对妇科手术患者产生免疫功能抑制作用较小，与其他麻醉方法相比较患者术后免疫功能恢复更快，是临床上妇科患者手术麻醉的理想方法，值得在临床上进行推广应用。

[关键词] 免疫功能；妇科手术；麻醉；影响

[中图分类号] R314 [文献标识码] A [文章编号] 1673-7210（2017）06（a）-0059-04

Effects of different anesthesia methods on immune function in patients with gynecological surgery

CHEN Xinyan WANG Lei NIU Shikun FANG Xianjie

Department of Anesthesiology， Shiyan Maternal and Child Health-Care Hospital， Hubei Province， Shiyan 442000，China

[Abstract] Objective To observe and analyze the effects of different anesthesia methods on immune function in patients with gynecological surgery. Methods From February 2014 to December 2015， in Shiyan Maternal and Child Health-Care Hospital， 156 patients underwent gynecological surgery were selected， they were divided into three groups by the anesthesia method， group A was given Dexmedetomidine intravenous infusion combined with Sevoflurane inhalation anesthesia， group B was given Sevoflurane inhalation anesthesia， group C was given Propofol combined with Sufentanil anesthesia. The changes of SBP， DBP， HR， RR， SpO2， peripheral blood T lymphocyte subsets and inflammatory cytokines of all patients were observed at before anesthesia （T0）， after surgrey 2 h （T1），after surgrey 6 h （T2）， after surgrey 12 h （T3）， after surgrey 1 d （T4）， after surgrey 3 d （T5）， after surgrey 7 h （T6）. Results The levels of SBP at T1， T2， T3， DBP， RR at T1， T2， TNF-α at T1， T6， IL-6， IL-8 at T1-T6， CD3+ at T1， CD4+ at T1， T2 of group A were compared with those at T0， the differences were statistically significant （P < 0.05）. The levels of SBP at T1， T2， T3， RR at T1， T2， TNF-α at T1， T2， T5， T6， IL-6， IL-8 at T1-T6， CD3+ at T1， CD4+ at T1， T2， T3 of group B were compared with those at T0， the differences were statistically significant （P < 0.05）. The levels of SBP at T1， T2， T3， TNF-α at T1， T4-T6， IL-1β at T6， IL-6， IL-8 at T1-T6， CD3+， CD4+ at T1 of group C were compared with those at T0， the differences were statistically significant （P < 0.05）. The levels of IL-6 at T1-T6， IL-8 at T1， T5， T6 of group B， the levels of TNF-α at T5， IL-6，IL-8 at T1-T6 of group C were compared with those at the same time points of group A， the differences were statistically significant （P < 0.05）. The levels of IL-6， IL-8 at T1-T6 of group C were compared with those at the same time points of group B， the differences were statistically significant （P < 0.05）. Conclusion The combination of Dexmedetomidine and Sevoflurane inhalation has a transient inhibitory effect on the immune function of gynecological patients. Compared with other anesthesia methods， the immune function recovered more quickly after surgery， which is anesthesia for gynecological patients ideal method， it is worth to popularize and apply in clinic.

[Key words] Immune function； Gynecological surgery； Anesthesia； Influences

宫腔镜电切术在临床治疗方面具有手术创伤小，术后恢复快的优点，现在广泛应用于临床治疗子宫肌瘤和内膜息肉等疾病。如果在患者清醒状态下进行宫腔镜电切术，患者疼痛感较强，容易造成患者频繁体动，对手术操作造成影响，所以需对患者进行麻醉[1]。右美托咪定是一种具有镇静、镇痛等作用的复合麻醉药物，是一种具有高选择性的高效α2肾上腺素受体激动剂[2]。有研究人员认为，对于进行妇科手术的患者容易因手术应激而产生免疫抑制，从而延长了术后恢复时间，增加了术后并发症的发生率，增加了肿瘤类疾病患者机体内肿瘤细胞生存，并且提高了体内转移灶的产生概率[3-5]。……