术后PCIA对肺癌患者细胞免疫功能的影响

Effects of PCIA in immune function of patients with Lung cancer

目的观察术后持续静脉阵痛(PCIA)对肺癌患者细胞免疫功能的影响,探讨其对肺癌患者免疫功能的保护性作用。方法选择肺癌患者50例,随机分为Ⅰ组(PCIA)和Ⅱ组(对照组,根据病人术后疼痛情况给予间断肌注呱替啶),每组25例,均行全身麻醉。两组病人分别于麻醉前、术毕、术后24 h、48 h、168 h采血测定T淋巴细胞亚群(CD3、CD4、CD8)百分率。计算CD4/CD8的值,测NK细胞及IL-2和IL-6的含量。两组病人在术后5 h、24 h行VAS评分。结果①Ⅰ组病人VAS评分均显著低于Ⅱ组病人(P<0.05)。②麻醉前两组病人所测的CD3、CD4、CD8、CD4/CD8,NKcell,IL-2和IL-6值无明显差别(P>0.05)。Ⅰ组病人术毕及术后24 h CD3、CD4、NK细胞含量较麻醉前下降(P<0.005),而CD8含量较麻醉前升高(P<0.005)。Ⅱ组病人术毕及术后24 h、48 h CD3、CD4、NK细胞含量较麻醉前下降(P<0.05),而CD8含量较麻醉前升高(P<0.005)。但术后24 h、48 hⅠ组病人CD3、CD4、NK细胞水平高于Ⅱ组病人(P<0.05),而CD8含量低于Ⅱ组病人(P<0.05)。Ⅰ组病人术毕及术后24 h IL-2含量较麻醉前降低(P<0.05),而IL-6含量较麻醉前升高(P<0.05)。Ⅱ组病人术毕及术后24 h、48 hIL-2含量较麻醉前降低(P<0.05),而IL-6含量较麻醉前升高(P<0.05)。但术后24 h、48 h①组病人IL-2含量高于Ⅱ组病人(P<0.05),而IL-6含量Ⅰ组病人低于Ⅱ组病人(P<0.05)。结论肺癌患者术后行PCIA可有效减轻术后疼痛,在一定程度上减轻了免疫抑制,对病人的免疫功能起到了一定的保护作用。

Objective To investigate the effect of postoperative continuous venous injection analgesia （PCIA） on T Lymphocytic cell subpopnlation,NK Cell,Interleuldn-2 （IL-2） and Interleuldn-6 （IL-6） in patients with Lung cancer. Methods Fifty patients with Lung cancer were randomly divided into two groups： group Ⅰ was postoperative continuous venous injection analgesia （ n = 25） ; group Ⅱ was control group （ n = 25）. VAS scores were measured at 5 h and 24 h after operation respectively. Blood samples were taken before anesthesia, operation end and postoperative 24 h,48 h, 168 h for the determination of T Lymphocytic cell subpopulation （CD3, CD4, CD8, CD4/D8）, NK cell, Interleuldn-2 （IL-2） and Intherkuldn-6 （IL-6）. Results VAS scores of group Ⅰ were markedly lower than that of group Ⅱ in postoperative 5h and 24h （ P 〈 0.05）. Before anesthesia, there was no significant difference in T Lymphocytic cell subpopulation （CD3, CD4, CD8, CD4/D8）, NK cell, IL-2 and IL-6 between two groups （ P 〉 0.05）. The level of CD3,CD4,and NK cell were all decreased at operation end and postoperative 24 h,48 h in two groups compared with baseline value, while CD8 was increased. But at postoperative 24 h,48 h,the level of CD3,CD4,and NK cell in group Ⅰ was increased compared with group Ⅱ （P 〈 0.05）, while CD8 was decreased. Compare with baseline value, IL-2 was decreased at operation end and postop- erative 24 h,48 h in group Ⅰ ,while IL-6 was increased.The tendency was the same in group Ⅱ .IL-2 in group Ⅰ was higher than that of group Ⅱ at postoperative 24 h, 48 h, while IL-6 in group Ⅰ was lower than that of group Ⅱ （ P 〈 0.05）. Conclusion Post- operative continuous venous injection analgesia （PCIA） not only relief pain but also protect immune fuaction of patients. This might be beneficial to the patients with Lung cancer.