麻醉术后镇痛 [不同麻醉方法及术后镇痛对妇科手术患者C反应蛋白及补体变化的影响]

　　[摘要] 目的 探讨不同麻醉方法及术后镇痛对妇科手术患者C反应蛋白及补体变化的影响，以期找到更适合妇科手术的麻醉方法，减少术后并发症，以便缩短手术患者住院时间。 方法 60例择期行妇科手术的患者，ASA Ⅰ～Ⅱ级，随机均分为单纯硬膜外麻醉组（Ⅰ组，n = 20）、静脉复合麻醉组（Ⅱ组，n = 20）及静脉复合麻醉+硬膜外麻醉组（Ⅲ组，n = 20），分别在麻醉前（T1）、术毕（T2）、术后24 h（T3）及术后72 h（T4）分别抽取患者外周静脉血，测定C反应蛋白（CRP）及补体C3、C4水平。 结果 与同组内T1时段比较，三组患者CRP在T3、T4均有不同程度增高（P ＜ 0.05），但Ⅱ、Ⅲ组增高浓度在正常范围之内；与同时段组间比较，Ⅰ组CRP在T3、T4较Ⅱ、Ⅲ组增高，差异有统计学意义（P ＜ 0.05），Ⅱ、Ⅲ组之间比较差异无统计学意义（P ＞ 0.05）。与同组内T1时段比较，三组C3在T2时段有所降低（P ＜ 0.05），但在T3时段均能升至麻醉前水平；与其他两组比较，Ⅲ组C3在T3、T4增高，差异有统计学意义。与同组内T1或者与组间各时段相比较，三组C4在各时段变化差异无统计学意义。 结论 硬膜外阻滞麻醉复合静脉麻醉保留了单纯硬膜外麻醉和单纯静脉麻醉的优点，可明显减轻术中及术后应激反应，有利于补体系统的稳定，不失为妇科患者手术较为安全的麻醉方法。同时良好的术后镇痛能减轻妇科手术疼痛对免疫系统的抑制作用，值得在临床上广泛推广使用。
　　[关键词] 妇科手术；C反应蛋白；补体；术后镇痛
　　[中图分类号] R614.2 [文献标识码] A [文章编号] 1673-7210（2012）07（c）-0089-03
　　Effect of three different anesthesia methods and postoperative analgesia on the C reactive protein and complement in patients undergoing surgery of gynecology
　　GUAN Kaihua LU Handong LIANG Anwei TAN Renlin DENG Qunbo WEI Pingxuan
　　Department of Anesthesiology, the First People"s Hospital of Hechi City, Guangxi Zhuang Autonomous Region, Yizhou 546300, China
　　[Abstract] Objective To study the effect of three different anesthesia methods and postoperative analgesia on the C reactive protein (CRP) and complement in patients undergoing surgery of gynecology. Methods sixty patients were randomly divided into three groups: epidural anesthesia a lone (group Ⅰ, n = 20), balanced anesthesia (group Ⅱ, n = 20) and epidural anesthesia combined with balanced anesthesia (group Ⅲ, n = 20). CRP and complement in blood serum were detected at before induction (T1), the end of operative procedure (T2), 24 hour after operation (T3) and 72 hour after operation (T4). Results Compared to T1, CRP in three groups were significantly higher at T3, T4 respectively (P ＜ 0.05), but group Ⅱ and Ⅲ increased in a normal rang; compared to other groups at the same time, the extent of CRP in group Ⅰ were significantly increased at T3, T4 (P ＜ 0.05), while group Ⅱ, Ⅲ were not significantly different with each other. Compared to T1, C3 in three groups were significantly decreased at T2 respectively (P ＜ 0.05), but recovered to normal range in 24 hour after operation; Compared to the other group, C3 in group Ⅲ were significantly higher than those in group Ⅰ and Ⅱ respectively at T3, T4 (P ＜ 0.05). Compared to T1, C4 in three groups were not significantly changed at different time; compared to the other groups, C4 in three groups were not significantly different with each other. Conclusion Epidural anesthesia combined with balanced anesthesia retains the advantages of epidural anesthesia or balanced anesthesia. It can significantly reduce the stress response to surgery at interoperation and postoperation and profit to the stability of the complement system. It is a more secure method of anesthesia in patients undergoing surgery of gynecology. A good postoperative analgesia can reduce the inhibitory on the immune system by pain of gynecologic surgery and is worthy to be widely used in clinical practice.