全麻复合硬膜外麻醉对老年宫颈癌患者术中血压控制及术后血清MCP-1、GSH-Px水平变化的影响

全麻复合硬膜外麻醉对老年宫颈癌患者术中血压控制及术后血清MCP-1、GSH-Px水平变化的影响

张从利,邱正国

西电集团医院,西电集团医院

收稿日期:2017-11-09 修回日期:2017-11-13 出版日期:2017-12-25
基金资助:
陕西省科学技术应用课题项目（项目编号：1300271502；项目名称：硬膜外腔穿刺成功后置管困难临床研究）

Effects of General Anesthesia Combined with Epidural Anesthesia on Intraoperative Blood Pressure Control and Changes of Serum MCP-1 and GSH-Px Levels in Elderly Patients with Cervical Cancer

ZhangCongli and QiuZhengguo

Department of Anesthesiology,Department of Anesthesiology

Received:2017-11-09 Revised:2017-11-13 Online:2017-12-25

摘要/Abstract

摘要： 目的：分析全麻复合硬膜外麻醉对老年宫颈癌患者术中血压控制及术后血清单核细胞趋化蛋白-1（MCP-1）、谷胱甘肽过氧化物酶（GSH-Px）水平变化的影响。方法：选取2014年3月至2017年3月我院老年宫颈癌患者68例，随机数字表法分为观察组(34例)和对照组(34例)。两组均采取腹腔镜手术治疗，观察组予全麻复合硬膜外麻醉，对照组予全身麻醉。比较两组的麻醉效果、不良反应发生率、血压[收缩压（SBP）、舒张压（DBP）]、心率与手术前后血清MCP-1、GSH-Px水平。结果：观察组吸入异氟醚剂量较对照组减少，自主呼吸恢复及清醒时间较对照组缩短，差异有统计学意义（P＜0.05）；观察组麻醉优良率94.12%（32/34）高于对照组76.47%（26/34）（P＜0.05）；两组麻醉前SBP、DBP、心率比较，差异无统计学意义（P>0.05），观察组麻醉诱导后、气腹创建后、手术结束时的SBP、DBP、心率均低于对照组（P＜0.05）；两组术前血清MCP-1、GSH-Px水平比较，差异无统计学意义（P>0.05），观察组术后血清MCP-1水平低于对照组，血清GSH-Px水平高于对照组（P＜0.05）；观察组不良反应发生率5.88%（2/34）低于对照组26.47%（9/34）（P＜0.05）。结论：老年宫颈癌患者术中采取全麻复合硬膜外麻醉效果显著，可明显控制患者血压、心率变化情况，改善其血清MCP-1、GSH-Px水平，缓解氧化应激及炎症反应，促进其恢复，且不良反应少。

Abstract: Objective：To analyze the effects of general anesthesia combined with epidural anesthesia on intraoperative blood pressure control and serum monocyte chemoattractant protein-1 (MCP-1)， glutathione peroxidase (GSH-Px) levels in elderly patients with cervical cancer. Methods： From March 2014 to March 2017， 68 patients with cervical cancer in our hospital were randomly divided into observation group(34 cases) and control group(34 cases). The two groups were treated with laparoscopic surgery， the observation group was given general anesthesia combined with epidural anesthesia， the control group was given general anesthesia. The anesthetic effect， incidence of adverse reactions， blood pressure [systolic blood pressure(SBP)， diastolic blood pressure (DBP)]， heart rate and serum MCP-1 and GSH-Px levels before and after operation were compared between the two groups. Results： The inhalation isoflurane dose in the observation group was lower than that in the control group， and the spontaneous respiration recovery and awake time were shorter than the control group(P<0.05). The excellent and good rate of anesthesia in the observation group (94.12%， 32/34) was higher than that in the control group (76.47%， 26/34) (P<0.05). There was no significant difference in SBP， DBP and heart rate between the two groups before anesthesia(P>0.05)， the SBP， DBP and heart rate after anesthesia induction， after pneumoperitoneum was created， at the end of surgery in the observation group were significantly lower than that in the control group (P<0.05). There was no significant difference in the serum MCP-1 and GSH-Px levels between the two groups before operation(P>0.05)， but after operation， the serum MCP-1 level in the observation group was lower than that in the control group， and the serum GSH-Px level was higher than that of the control group (P<0.05). The incidence of adverse reactions in the observation group (5.88%， 2/34) was lower than that in the control group (26.47%， 9/34) (P<0.05). Conclusion： The effect of general anesthesia combined with epidural anesthesia in elderly patients with cervical cancer is significant， which can significantly control the blood pressure and heart rate change， improve the serum MCP-1 and GSH-Px levels， alleviate oxidative stress and inflammatory response， promote its recovery， and less adverse reactions.

张从利,邱正国. 全麻复合硬膜外麻醉对老年宫颈癌患者术中血压控制及术后血清MCP-1、GSH-Px水平变化的影响[J]. .

ZhangCongli and QiuZhengguo. Effects of General Anesthesia Combined with Epidural Anesthesia on Intraoperative Blood Pressure Control and Changes of Serum MCP-1 and GSH-Px Levels in Elderly Patients with Cervical Cancer[J]. .

参考文献

[1] Fitzpatrick R W,Cox J W,Fritsch E,et al.2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors:,Erratum[J].Journal of Lower Genital Tract Disease,2013,17(4):145–152.
[2] 沈芳玲,殷玉明,夏敏娟,等.海宁市宫颈癌筛查高风险人群评估及流行病学调查[J].中国计划生育学杂志,2015,23(9):595-599.
[3] 潘秦镜.TBS子宫颈细胞学报告系统回顾及新版解读[J].中国妇产科临床杂志,2017,18(1):95-96.
[4] Geetha P,Nair M K.Laparoscopic,robotic and open method of radical hysterectomy for cervical cancer: A systematic review[J].Journal of Minimal Access Surgery,2012,8(3):67-73.
[5]温宏武.腹腔镜手术治疗宫颈癌应用现状及进展[J].中国实用妇科与产科杂志,2015,31(6):573-576.
[6] 沈亚建,方军,周惠丹,等.七氟醚和丙泊酚对行腹腔镜宫颈癌根治术患者炎症因子及应激反应的影响[J].中华全科医学,2017,15(1):66-68.
[7] 田育斌,张萍,王伟.不同麻醉方法下宫颈癌手术患者术前、中、后外周血炎症相关细胞因子水平观察[J].中国医药导刊,2016,18(8):796-797.
[8] 胡佳,李有长,徐茜.全身麻醉联合硬膜外麻醉与单纯全身麻醉对妇科腹腔镜手术的麻醉效果比较[J].中国医药导报,2016,13(2):129-132.
[9] 谢幸,苟文丽.妇产科学[M].第8版.北京:人民卫生出版社,2013:304-309.
[10] 夏敏,周旺辉.全身麻醉联合硬膜外麻醉与单纯全身麻醉对宫颈癌手术围术期的一氧化氮和P物质水平及效果比较[J].中国妇幼保健,2016,31(19):4070-4074.
[11] Xu Y,Yu H,Qin H,et al.Inhibition of autophagy enhances cisplatin cytotoxicity through endoplasmic reticulum stress in human cervical cancer cells[J].Cancer Letters,2012,314(2):232-243.
[12].中国子宫颈癌筛查及异常管理相关问题专家共识(二)[J].中国妇产科临床杂志,2017,18(3):286-288.
[13] 薛卫东,李海龙,张先锋.不同麻醉方法在腹腔镜子宫切除术中的效果分析[J].右江民族医学院学报,2014,36(3):398-399.
[14]熊菊香,王沂峰,陈高文等.改良腹式与全腹腔镜广泛宫颈切除术治疗早期宫颈癌的比较[J].实用妇产科杂志,2015,31(4):310-314.
[15] 向梅,许国琴,莫怀忠,等.不同麻醉方法对宫颈癌根治术患者围术期免疫功能的影响[J].实用医学杂志,2015,31(11):1889-1890.
[16] 刘清华,李瑞娟.帕瑞昔布对宫颈癌腹腔镜手术患者炎性因子及镇痛效果的影响[J].癌症进展,2017,15(1):82-84.
[17]姚长青,刘兵,刘志永等.麻醉方式及深度对子宫颈癌患者围术期免疫功能的影响[J].山东医药,2017,57(5):62-64.
[18] 张安传,尹鸿.硬膜外复合全身麻醉与静吸复合全身麻醉对子宫切除术麻醉效果比较[J].医学综述,2016,22(16):3311-3314.
[19] 王晓光,李戈辉,齐晓非,等.不同麻醉方式对腹腔镜子宫切除术患者炎症反应及氧化应激反应的影响[J].海南医学院学报,2016,22(13):1446-1449.
[20] 郭絮飞.姜黄素对C-33 A人子宫颈癌细胞株增殖的影响及其相关机制[J].中国老年学杂志,2014,34(11):3082-3083.

快速检索引用检索图表检索高级检索