不同麻醉方式对腹腔镜全子宫切除2型糖尿病患者细胞免疫及血清炎症因子水平的影响

Effects of different anesthesia methods on cellular immunity and serum inflammatory factors in patients with type 2 diabetes mellitus undergoing laparoscopic hysterectomy

摘要:

目的 探讨不同麻醉方式对腹腔镜全子宫切除2型糖尿病（T2DM）患者细胞免疫及血清炎症因子水平的影响。方法 选取2016年1月—2019年1月邯郸市中心医院收治的120例拟行腹腔镜全子宫切除术的T2DM患者，采用随机数字表法分为A、B组，每组60例。A组采用靶控输注丙泊酚和瑞芬太尼全身麻醉，B组在A组基础上复合吸入七氟醚全身麻醉。比较两组T淋巴细胞（CD3⁺、CD4⁺及CD8⁺）、NK细胞（CD3^-CD16⁺CD56⁺）、血清白细胞介素-6（IL-6）、超敏C反应蛋白（hs-CRP）、降钙素原（PCT）、IL-10水平及术中不良反应。结果 两组麻醉前（T₀）、建立气腹前（T₁）、建立气腹后90 min（T₂）、术后第1天（T₃）及术后第3天（T₄）CD3⁺、CD4⁺、CD8⁺、CD3^-CD16⁺CD56⁺和IL-6、hs-CRP、PCT、IL-10水平比较，在不同时间、不同组间及变化趋势上有差异（P <0.05）。B组苏醒时间、拔管时间短于A组（P <0.05）。两组麻醉维持时间、术中恶心呕吐、牵拉反应及低血压发生率比较，差异无统计学意义（P >0.05）。结论 靶控输注丙泊酚和瑞芬太尼复合七氟醚吸入全身麻醉可降低全子宫切除术T2DM患者围手术期血清炎症因子水平，保护细胞免疫功能，且不增加术中不良反应，具有一定的临床应用价值。

Abstract:

Objective To investigate the effects of different anesthesia methods on cellular immunity and serum inflammatory factors in patients with type 2 diabetes mellitus (T2DM) undergoing laparoscopic hysterectomy.Methods We enrolled 120 T2DM patients undergoing laparoscopic hysterectomy in our hospital from January 2016 to January 2019, and divided them into two groups with the method of random number table. Group A (60 cases) received general anesthesia with target controlled infusion of propofol and remifentanil, while group B (60 cases) received general anesthesia with propofol and remifentanil combined with sevoflurane inhalation. The levels of T lymphocytes (CD3⁺, CD4⁺, CD8⁺), natural killer cells (CD3^-CD16⁺CD56⁺), serum interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), and interleukin-10 (IL-10) as well as adverse reactions during operation were compared between the two groups.Results The levels of CD3⁺ cells, CD4⁺ cells, CD8⁺ cells, CD3^-CD16⁺CD56⁺ cells, IL-6, hs-CRP, PCT and IL-10 were different between the groups and altered at different time points [before anesthesia (T0), before pneumoperitoneum (T₁), 1.5 hours after pneumoperitoneum (T₂), 1 day after operation (T₃), and 3 days after operation (T₄)] with distinct changing trends (P < 0.05). The recovery time and extubation time in group B were shorter than those in group A (P < 0.05). There was no significant difference in the duration of the maintenance of anesthesia, and the incidences of intraoperative nausea and vomiting, traction reaction and hypotension between group B and group A (P > 0.05).Conclusions General anesthesia with target controlled infusion of propofol and remifentanil combined with sevoflurane inhalation can reduce the level of serum inflammatory factors, protect the cellular immune function, and do not increase the adverse reactions during operation in T2DM patients undergoing laparoscopic hysterectomy, which is of certain value for clinical application.