CAJ | 학술논문

目的：探讨不同麻醉方式对老年食管癌患者围手术期外周血T淋巴细胞亚群的影响。方法84例的老年食管癌患者（≥65岁），按麻醉方式的不同分为观察组、对照组，每组42例，观察组进行静脉复合全麻联合胸部硬膜外阻滞，对照组进行静脉复合全麻，分别于麻醉前、术毕、术后24 h、术后48 h、术后120 h时段抽取外周静脉血，检测各时段皮质醇水平；检测外周血T淋巴细胞亚群CD3＋、CD4＋、CD4＋／CD8＋水平；比较两组各时段皮质醇水平及外周血T淋巴细胞亚群水平。结果观察组术毕、术后24 h、术后48 h、术后120 h皮质醇水平变化幅度显著低于对照组，差异有统计学意义（ P＜0．05）；两组术毕、术后24 h、术后48 h外周血T淋巴细胞亚群CD3＋、CD4＋、CD4＋／CD8＋水平显著低于麻醉前，差异有统计学意义（P＜0．05）；观察组术后120 h各T淋巴细胞指标水平恢复（P＞0．05）；观察组术后24 h、术后48 h、术后120 h外周血T淋巴细胞亚群CD3＋、CD4＋、CD4＋／CD8＋水平显著高于对照组，差异有统计学意义（ P ＜0．05）。结论全麻联合胸部硬膜外麻醉可降低老年食管癌患者围术期应激反应及对T淋巴细胞亚群的影响，可作为老年食管癌患者首选麻醉方式，值得临床推广。
목적：탐토불동마취방식대노년식관암환자위수술기외주혈T림파세포아군적영향。방법84례적노년식관암환자（≥65세），안마취방식적불동분위관찰조、대조조，매조42례，관찰조진행정맥복합전마연합흉부경막외조체，대조조진행정맥복합전마，분별우마취전、술필、술후24 h、술후48 h、술후120 h시단추취외주정맥혈，검측각시단피질순수평；검측외주혈T림파세포아군CD3＋、CD4＋、CD4＋／CD8＋수평；비교량조각시단피질순수평급외주혈T림파세포아군수평。결과관찰조술필、술후24 h、술후48 h、술후120 h피질순수평변화폭도현저저우대조조，차이유통계학의의（ P＜0．05）；량조술필、술후24 h、술후48 h외주혈T림파세포아군CD3＋、CD4＋、CD4＋／CD8＋수평현저저우마취전，차이유통계학의의（P＜0．05）；관찰조술후120 h각T림파세포지표수평회복（P＞0．05）；관찰조술후24 h、술후48 h、술후120 h외주혈T림파세포아군CD3＋、CD4＋、CD4＋／CD8＋수평현저고우대조조，차이유통계학의의（ P ＜0．05）。결론전마연합흉부경막외마취가강저노년식관암환자위술기응격반응급대T림파세포아군적영향，가작위노년식관암환자수선마취방식，치득림상추엄。
Objective To analyze the effect of different anesthesia methods on perioperative T lymphocyte subsets of pe-ripheral blood in elderly patients with esophageal cancer.Methods 84 cases of elderly patients with esophageal cancer ( over 65 years) ,according to different anesthesia methods,were divided into the observation group and the control group,42 cases in each group,the observation group received intravenous anesthesia combined with thoracic epidural anesthesia, the control group re-ceived intravenous combined anesthesia.Peripheral blood were collected before anesthesia,surgery,24 h,48 h,and 120 h after op-eration,and the serum cortisol levels,T lymphocyte subsets of peripheral blood CD3 +、CD4 +、CD4 +/CD8 +levels were detected;the level of T lymphocyte subsets of peripheral blood and serum cortisol level were compared between the 2 groups.Results In the observation group,cortisol levels 24 h,48 h and 120h after operation were significantly lower than those of the control group, the difference was statistically significant (P<0.05);in the 2 group,T lymphocyte subsets of peripheral blood CD3 +、CD4 +、CD4 +/CD8 +levels 24 h,48 h after operation were significantly lower than before anesthesia,the difference was statistically signif-icant (P<0.05);in the observation group,T lymphocyte subsets of peripheral blood 120 h after operation recovered (P >0.05);in the observation group,24 h,48 h,120 h after operation,T lymphocyte subsets of peripheral blood CD3 +、CD4 +、CD4 +/CD8 +levels were significantly higher than those of the control group,the difference was statistically significant (P<0.05).Con-clusion General anesthesia combined with thoracic epidural anesthesia can decrease perioperative stress response and influence on T lymphocyte subsets in elderly patients with esophageal cancer,which can be used as the preferred mode of anesthesia for eld-erly esophageal cancer patients,it is worthy of clinical promotion.