硬膜外麻醉联合多模式镇痛对全身麻醉腹腔镜妇科手术患者免疫功能及高迁移率族蛋白B1的影响

Effects of epidural anesthesia combined with multimodal analgesia on immune function and HMGB1 after laparoscopic gynecological surgery under general anesthesia

摘要:

目的 探讨硬膜外麻醉联合多模式镇痛对全身麻醉（以下简称全麻）腹腔镜妇科手术患者免疫功能及高迁移率族蛋白B1（HMGB1）的影响。方法 选取2018年1月—2022年1月南通大学附属妇幼保健院收治的112例拟行全麻腹腔镜妇科手术患者，分为对照组和研究组，每组56例。研究组给予全身麻醉复合硬膜外麻醉联合多模式镇痛，对照组给予全身麻醉联合多模式镇痛。分析两组患者术中血流动力学指标的变化，比较两组患者术后疼痛情况，对比两组患者围术期HMGB1、应激反应及免疫功能情况，统计两组患者围术期麻醉药物相关不良反应发生情况。结果 两组患者麻醉诱导前、气腹建立后5 min、放气后5 min的心率、平均动脉压（MAP）比较，经重复测量设计的方差分析，结果 ①不同时间点的心率、MAP有差异（P <0.05）；②两组患者心率、MAP有差异（P <0.05），研究组较对照组低，相对血流动力学较稳定；③两组患者心率、MAP变化趋势有差异（P <0.05）。两组患者术前、术后24 h、术后48 h的HMGB1水平比较，经重复测量设计的方差分析，结果 ①不同时间点的HMGB1水平有差异（P <0.05）；②两组患者HMGB1水平有差异（P <0.05），研究组术后较对照组低，炎症反应较轻；③两组患者HMGB1水平变化趋势有差异（P <0.05）。两组患者术前、术后24 h、术后48 h的肾上腺素（Adr）、皮质醇（Cor）比较，经重复测量设计的方差分析，结果 ①不同时间点间的Adr、Cor有差异（P <0.05）；②两组患者Adr、Cor有差异（P <0.05），研究组治疗后较对照组低，围术期应激反应轻较；③两组患者Adr、Cor变化趋势有差异（P <0.05）。两组患者术前、术后24 h、术后48 h的CD4⁺/CD8⁺比较，经重复测量设计的方差分析，结果 ①不同时间点的CD4⁺/CD8⁺有差异（P <0.05）；②两组患者CD4⁺/CD8⁺有差异（P <0.05），研究组较对照组高，免疫抑制较轻；③两组患者CD4⁺/CD8⁺变化趋势有差异（P <0.05）。两组患者不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 硬膜外麻醉联合多模式镇痛用于全麻腹腔镜妇科手术可稳定术中血流动力学指标，降低术后疼痛，抑制炎症因子HMGB1分泌，减轻免疫抑制及应激反应，且安全性较好。

Abstract:

Objective To investigate the effects of epidural anesthesia combined with multimodal analgesia on immune function and high mobility group protein B1 (HMGB1) after laparoscopic gynecological surgery under general anesthesia.Methods A total of 112 patients who were admitted to our hospital from January 2018 to January 2022 and underwent laparoscopic gynecological surgery under general anesthesia were selected and divided into control group and study group, with 56 cases in each group. The study group was given epidural anesthesia combined with multimodal analgesia on the basis of general anesthesia, while the control group was given general anesthesia combined with multimodal analgesia. The intraoperative changes of hemodynamic indexes of the two groups were recorded. Postoperative pain was compared between the two groups. Perioperative HMGB1, stress response and immune function were also compared between the two groups. The incidence of anesthetic adverse drug reactions in the two groups during the perioperative period was analyzed.Results Comparison of heart rate and mean arterial pressure (MAP) between the study group and the control group before anesthesia induction (T₀), 5 min after establishment of pneumoperitoneum (T₁) and 5 min after deflation of pneumoperitoneum (T₂) showed differences in heart rate and MAP at different time points (P < 0.05). The heart rate and MAP of the study group were lower than those of the control group, indicating more stable hemodynamics (P < 0.05). There were differences in the change trends of heart rate and MAP between the study group and the control group (P < 0.05). Comparison of HMGB1 between the study group and the control group before, and 24 h and 48 h after the surgery showed differences in HMGB1 at different time points (P < 0.05). Compared with the control group, HMGB1 in the study group was lower (P < 0.05), which suggested milder inflammatory response. Besides, the change trend of HMGB1 was different between the study group and the control group (P < 0.05). Comparison of adrenalin (Adr) and cortisol (Cor) between the study group and the control group before, and 24 h and 48 h after the surgery showed differences in Adr and Cor at different time points (P < 0.05), and also between the study group and the control group (P < 0.05). Specifically, the levels of Adr and Cor were lower in the study group, reflecting milder stress response. The change trends of Adr and Cor were different between the study group and the control group (P < 0.05). Comparison of CD4⁺/CD8⁺ between the study group and the control group before, and 24 h and 48 h after the surgery showed differences in CD4⁺/CD8⁺ at different time points (P < 0.05). Compared with the control group, CD4⁺/CD8⁺ was higher in the study group (P < 0.05), demonstrating milder immune suppression. The change trend of CD4⁺/CD8⁺ was different between the study group and the control group (P < 0.05). There was no significant difference in the overall incidence of adverse reactions between the two groups (P > 0.05).Conclusions Epidural anesthesia combined with multimodal analgesia in laparoscopic gynecological surgery under general anesthesia can stabilize intraoperative hemodynamic indexes, reduce postoperative pain, inhibit the secretion of inflammatory factor HMGB1, and relieve immune suppression and stress response with few safety concerns.