目的：探讨硬膜外阻滞复合全身麻醉与单纯全身麻醉分别联合术后镇痛对乳腺癌手术患者细胞免疫功能、血液动力学及预后的影响。方法：简单随机抽样法对90例女性乳腺癌患者进行分组,2组患者均给予乳腺癌手术,观察组(45例)采用硬膜外阻滞复合全身麻醉,且术后行自控硬膜外镇痛,对照组(45例)采用单纯全身麻醉,且术后行自控静脉镇痛；两组均于多个时间点检测平均动脉压(MAP)、心率(HR)、皮质醇、C反应蛋白(CRP)、T淋巴细胞亚群水平,行疼痛视觉模拟评分(VAS),并比较两组麻醉后恢复室(PACU)停留时间、下床活动时间及术后住院时间。结果：与入室时相比,两组诱导气管插管后、切皮后5min、拔管前等时刻MAP、HR均明显升高(P <0.05),而观察组气管插管后、切皮后5min、拔管前等时刻的MAP、HR均明显低于对照组(P <0.05)。术后4h、24h、48h等时间上,观察组血清皮质醇、CRP水平及疼痛VAS评分均明显低于对照组(P <0.05)。 术后4h、24h等时间上,观察组CD3+、CD4+及CD4+/CD8+均明显高于对照组(P <0.05)。观察组PACU停留时间、下床活动时间及术后住院时间均明显短于对照组,差异有统计学意义(P <0.05)。结论：对于乳腺癌手术患者,硬膜外复合全麻及术后自控硬膜外镇痛有助于维持手术过程中血液动力学稳定,抑制应激反应,减轻免疫抑制,促进患者快速恢复。

Objective: To investigate the effect of epidural block combined with general anesthesia and simple general anesthesia respectively combined with postoperative analgesia on cellular immune function, hemodynamics and prognosis of patients undergoing surgery for breast cancer. Methods: 90 female patients with breast cancer were grouped by the simple random sampling method. All subjects were treated with surgery. The observation group (45 patients) were given epidural block combined with general anesthesia and postoperative patient-controlled intravenous analgesia, while the control group (45 patients) were given simple general anesthesia and postoperative patient-controlled intravenous analgesia. The mean arterial pressure (MAP), heart rate (HR), cortisol, levels of C reactive protein (CRP) and T lymphocyte subsets were detected at various time points. The pain degree was evaluated with the visual analogue scale (VAS). The length of stay in postanesthesia care unit (PACU), time to get out of bed and postoperative length of hospital stay were compared between the two groups. Results: MAP and HR of both groups increased significantly after tracheal intubation, at 5min after skin incision and before extubation (P < 0.05). The MAP and HR of the observation group were significantly lower than those of the control group after tracheal intubation, at 5 min after incision and before extubation (P <0.05). Levels of serum cortisol and CRP and pain VAS scores in the observation group at 4h, 24h and 48h after operation were significantly lower than those in the control group (P < 0.05). CD3+, CD4+ and CD4+/CD8+ in the observation group were significantly higher than those in the control group at 4h and 24h after operation (P <0.05). The length of stay in PACU, time to get out of bed and postoperative length of hospital stay of the observation group were significantly shorter than those of the control group (P < 0.05). Conclusion: For patients undergoing surgery for breast cancer, epidural block combined general anesthesia and postoperative patient-controlled epidural analgesia can help maintain hemodynamic stability during operation, inhibit stress response, reduce immunosuppression, and promote recovery of patients.