不同镇痛方法对围术期T细胞亚群的影响

Influence of differential analgesic techniques on the immune response in elder postoperative patients of lung carcinoma

目的 比较持续硬膜外与持续静脉镇痛对老年肺癌患者术后免疫功能的影响。方法 4 5例择期行肺手术的老年患者 ,随机分为对照组 (N组 )、硬膜外镇痛组 (E组 )及静脉镇痛组 ( 组 ) ,分别于麻醉前、后 1h、2 4 h、4 8h、72 h抽血 ,抗凝处理后立即送检 ,测定 CD+ 3、CD4 + 、CD8+ ,并计算 CD4 + /CD8+ 比值。结果 T细胞亚群、CD+ 4/CD+ 8比值均明显下降 (P<0 .0 5 ) ,但 E组恢复较 组快 (P<0 .0 5 )。结论 两种镇痛方法均能获得满意的镇痛效果 ,与静脉镇痛相比 ,硬膜外镇痛可有效减轻围术期的免疫抑制 ,有利于老年患者免疫功能的早期恢复。

Objective To evaluate the influence of two analgesic techniques on the immune response in elder postoperative patients of lung carcinoma.Methods Forty-five elder patients undergoing selective pulmonary operation were randomly assigned to a contrast group (group N), an epidural analgesia group (group E) and an intravenous analgesia group (group I). Blood samples were taken before induction of anesthesia and 1h, 24h, 48h, 72h after induction of anesthesia, T-lymphocyte subsets (CD 3 +, CD 4 +, CD 8 +) and CD + 4/CD + 8 odds were measured in a timely fashion.Results The analgesial effects were similar among the groups. CD + 3, CD + 4, CD + 8 and CD + 4/CD + 8 odds decreased significantly (P<0.05) in the groups, but the reversion of which was quicker in the group E than that in the group I (P<0.05). Conclusion In elder patients after pulmonary operation, epidural and intravenous analgesia are both effective compared with intravenous analgesia. The epidural analgesia could decrease immunosuppression during perioperation, which is advantageous to recover immunological function earlier in elder patients after pulmonary operation.