硬膜外阻滞麻醉对乳腺癌根治术患者应激和血液流变学的影响

目的 观察连续硬膜外阻滞麻醉对乳腺癌根治术患者应激和血液流变学的影响.方法 40例ASA Ⅰ～Ⅱ级行择期乳腺癌根治术患者随机分为两组:Ⅰ组为全麻组;Ⅱ组为硬膜外阻滞麻醉加全麻组,于麻醉前(T0)、麻醉后30 min(T1)、麻醉后90 min(T2)、术后3 d(T3)检测外周血T淋巴细胞亚群的变化及血液流变学指标.结果 两组患者T1、T2时点CD3、CD4、CDs、CD4/CD8均下降,术后3d,Ⅱ组指标明显恢复至接近T0水平,与Ⅰ组比较均有统计学差异(P均＜0.05).两组均有全血黏度、红细胞压积及红细胞聚集指数下降,但Ⅱ组该3项指标下降明显且持续时间长,伴有血浆黏度及纤维蛋白原浓度的下降.结论 硬膜外阻滞能抑制应激反应对血液流变学的影响,更有利于预防乳腺癌根治术后上肢静脉血栓的形成.

The influences of epidural anesthesia on stress and haemorheology in patients undergoing breast cancer radical operation

Objective To observe the influences of continuous epidural anesthesia on stress and haemorheology in the patients undergoing breast cancer radical operation.Methods Forty breast cancer patients(ASA grade I-II) undergoing radical operation on schedule were randomly divided into two groups(n = 20 each):general anesthesia group(group I) and genera anesthesia combined with epidural anesthesia group(group II).The changes of T-lymphocytes subsets of peripheral blood and the indicators of haemorheology were detected before anesthesia(T0),30 min after anesthesia(T1),90 min after anesthesia(T2) and 3 days after surgery(T3).Results Compared with T0,CD3,CD4,CD8 and CD4 /CD8 decreased at T1 and T2 in the two groups(all P < 0.05).All aforementioned indicators returned to near baseline levels at T3 in group II,and there were statistical differences between groups I and II(all P < 0.05).Compared with T0,blood viscosity,hematocrit and RBC aggregation index were all lower at T1 in two groups(all P < 0.05),but those decreased markedly and the continued longer time in group II compared with group I;moreover the decreases of plasma viscosity and concentration of fibrinogen were accompanied in group II.Conclusion During breast cancer radical operation,epidural anesthesia can inhibit the influences of stress reaction to haemorheology,and therefore it is helpful in preventing postoperative venous thrombosis.