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目的探讨两种麻醉方法在围术期对乳腺癌根治术患者血清相关应激激素水平的影响。方法将80例乳腺癌患者按麻醉方法不同分为A、B两组各40例。A组采用硬膜外阻滞复合静脉全麻、B组采用全凭静脉麻醉,术后两组患者均行自控静脉镇痛。分别于麻醉前30min(T0)、切皮后1h(T1)、术后4h(T2)、24h(T3)和48h(T4)等5个时点检测患者血清PRL、GH、IL-8和IFN-γ浓度,观察不同麻醉方法及术后镇痛方式对恶性肿瘤患者围麻醉期相关应激激素水平的影响。结果 (1)两组患者血清PRL含量均随手术进程缓慢升高,且在T1时达到高峰,然后逐渐下降,各时点间PRL含量比较差异有统计学意义(P<0.05)。其中B组患者血清PRL含量在T1时显著高于A组(P<0.05)。(2)两组患者血清GH含量亦随手术进程缓慢升高,且在T2时达到高峰,然后又逐渐下降;其中A组患者血清GH含量在T1、T2时达高峰,而在各时点B组患者血清GH含量均高于A组。(3)两组患者血清IL-8含量在T1、T2、T3和T4时点均小于T0(P<0.05),且A组患者血清IL-8含量均小于B组(P<0.05)。(4)两组患者血清中IFN-γ的含量均随着手术进程缓慢升高,均在T3、T4时点达高峰。结论用硬膜外阻滞复合静脉全麻能够更好的抑制乳腺癌根治术中的患者应激反应。
Objective To investigate the effects of two anesthesia methods on serum levels of stress hormones in patients undergoing radical mastectomy for breast cancer during perioperative period. Methods Eighty patients with breast cancer were divided into A and B groups according to the method of anesthesia. A group with epidural block combined with intravenous anesthesia, B group with total intravenous anesthesia, postoperative two groups of patients underwent controlled intravenous analgesia. Serum levels of PRL, GH, IL-8 and IFN were measured at 5 min before T0, 1 h (T1), 4 h (T2), 24h (T3) and 48 h -γconcentration, and to observe the effects of different anesthesia methods and postoperative analgesia on the levels of stress hormones associated with perioperative anesthesia in patients with malignant tumors. Results (1) Serum PRL levels in both groups increased slowly with the course of operation and peaked at T1, then decreased gradually. There was significant difference in PRL content between the two groups (P <0.05). The serum PRL level in group B was significantly higher than that in group A at T1 (P <0.05). (2) Serum GH levels in both groups also increased slowly with the progression of the operation and peaked at T2, and then gradually decreased. Serum GH levels in group A reached a peak at T1 and T2, and at each time point B Group GH serum GH levels were higher than the A group. (3) Serum IL-8 levels in both groups were significantly lower than T0 at T1, T2, T3 and T4 (P <0.05), and serum IL-8 in group A was lower than that in group B (P <0.05). (4) The levels of IFN-γ in serum of both groups increased slowly with the progress of surgery, reaching the peak at T3 and T4. Conclusion Combined epidural blockade with intravenous general anesthesia can better inhibit the stress response in patients with radical mastectomy.