术后硬膜外镇痛对肺癌根治术患者血浆炎性细胞因子和自然杀伤细胞的影响

Effects of postoperative epidural analgesia on inflammatory cytokine and NK cell in patients after radical lung cancer surgery

目的评价术后硬膜外镇痛对肺癌根治术患者血浆炎性细胞因子和自然杀伤(NK)细胞的影响。方法择期行肺癌根治术患者30例,术后按镇痛方法不同均分为硬膜外自控镇痛(PCEA)组(E组)和静脉自控镇痛(PCIA)组(I组)。E组硬膜外输注含0.125%布比卡因、芬太尼2.4μg/ml和咪唑安定0.05mg/ml的混合液;I组静脉输注含芬太尼20μg/ml、咪唑安定0.1mg/ml和托烷司琼0.04mg/ml混合液。分别于麻醉前(T1)、术后2h(T2)、术后1d(T3)、3d(T4)、5d(T5)、7d(T6)抽取外周静脉血,检测干扰素-γ(IFN-γ)、肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-2、IL-4、IL-5、IL-10和NK细胞及血常规。采用VAS评估镇痛效果,用Ramsay方法评估镇静程度。结果两组VAS评分、恶心呕吐及术后感染的发生率差异无统计学意义;与I组相比,E组Ramsay镇静评分、TNF-α和IL-5降低(P<0.05),IL-2、IFN-γ和NK细胞活性升高(P<0.05)。结论与PCIA相比,PCEA能抑制促炎性细胞因子的释放,改善NK细胞的活性。

Objective To investigate the effects of postoperative epidural analgesia on inflammatory cytokines and natural killer （NK） cells in patients after radical lung cancer surgery. Methods Thirty patients aged 30-65 years old underwent lung cancer surgery under general anesthesia were randomized to receive either postoperative patient-controlled intravenous analgesia （PCIA）（group I） or epidural analgesia （PCEA） （group E） for 72 h with 15 cases each. The PCIA solution contained fentanyt 20 μg/ml, midazolam 0. 1 mg/ml and tropisetron 0.04 mg/ml. The PCEA solution contained 0. 125% bupivacaine,fentanyl 2.4μg/ml and midazolam 0.05 mg/ml. The analgesia and sedation were evaluated by VAS and Ramsay sedation seore（RSS） respectively. Blood samples were taken before induction （T1）, at 2 h （T2） and on the 1^st（T3）, 3^rd （T4）, 5^th （T5） and the 7^th postoperative day（T6 ） for detecting plasma concentrations of interleukin （ IL）-2, IL -4, IL -5, IL -10, interferon（IFN）-γ,tumor necrosis（TNF）-α and NK cells and WBC counts. Results There were no significant differences in VAS score and incidence of nausea and vomiting between the two groups during analgesia. RSS and plasma concentration of TNF-α and IL-5 were significantly lower and the level of NK cells and the plasma concentration of IL-2 and IFN-γ were significantly higher in group E than those in group I （P〈0.05）. Conclusion Postoperative epidural analgesia can inhibit the release of pro-inflammatory cytokines and increase the activity of NK cells.