下腹部手术后不同镇痛方法对T细胞亚群的影响

Effects of different postoperative analgesia methods on T cells subgroups after lower adbominal surgery

目的通过观察择期下腹部手术患者术后采用不同的镇痛方法对T细胞亚群的影响,以探讨硬膜外术后镇痛的免疫保护作用。方法50例ASA分类Ⅰ～Ⅱ级择期下腹部手术患者,随机分为2组：A组采用术后硬膜外镇痛,B组采用术后静脉镇痛,观查不同时间的VSA评分。分别于麻醉前（T1）、术毕（T2）、术后第1天（T3）及第3天（T4）抽取外周静脉血,检测T淋巴细胞亚群,CD4、CD8、CD4/CD8。结果2组患者一般情况无差别。与B组比较A组患者术后2 h、术后1 d、术后2 d和术后3 d VAS评分明显降低（P〈0.01）。2组患者T淋巴细胞亚群的测定,与T1相比,2组患者在T2和T3CD＋^4、CD^4＋/CD^8＋均明显下降（P〈0.05）,但与A组比较,B组T2、T3和T4CD^4＋、CD^4＋/CD^8＋下降更为显著（P〈0.05）,A组患者CD^4＋、CD^4＋/CD^8＋在T4已恢复至T1水平,而2组患者CD^8＋则变化不明显。结论下腹部手术患者术后采用不同的镇痛方法,发现术后硬膜外镇痛具有较好的镇痛作用,对术后的免疫功能具有较好的保护作用。

Objective To study the effect of postoperative analgesia method on patient＇s T cells subgroups after lower abdominal surgery, and to explore protection immunity of epidural analgesia. Methods Fifty patients, ASA grade Ⅰ - Ⅱ, who would undergo lower abdominal surgery,were divided into two groups. Group I were given analgesic drugs by vein injection. The degrees of postoperative pain in both groups were compared. The peripheral blood samples of both groups were compared. The peripheral blood samples of both groups were obtained before anesthesia （ T1 ） , at the end of operation （ T2 ） , on the first day （T3 ） and the third day after operation （ T4 ） to determine T cell subgroups. Results VAS score was obviously lower in group Ⅰ compared with group Ⅱ. CD4 ^＋ and CD4 ^＋/CD8 ^＋ at T2, T3 were obviously decreased compamed with T1 （ P 〈 0.05 ） in two groups. CD4 ^＋ and CD4 ^＋/CD8 ^＋ at T2 ,T3 in group Ⅰ were remarkably decreased compamed with Group Ⅱ （ P 〈 0. 05 ）. CD8 ^＋ in two groups had no change. Conclusion PCEA is a better postoperative analgesia method after lower abdominal surgery, which has a better immunity protection.