不同术后自控镇痛对老年宫颈癌患者术后免疫功能的影响

Effect of PCIA and PCEA on T lymphocyte,NK cell of cervical cancer

目的研究静脉自控镇痛(PCIA)与硬膜外自控镇痛(PCEA)对老年宫颈癌患者根治术后T细胞、NK细胞的影响,为选择合适的镇痛方式提供理论依据。方法将92例老年宫颈癌患者根治术病例,根据所使用的镇痛方式分为3组:PCIA组(38例),PCEA组(36例),对照组(18例)。在诱导麻醉前、手术开始2 h、术后6 h、术后24 h、术后3 d、术后7 d时间点上抽取外周静脉血检测血清T细胞亚群及NK细胞活性。结果 3组病例在麻醉和手术后NK细胞活性明显下降、CD4降低、CD8升高,CD4/CD8比值下降,在术后3 d左右开始恢复,术后7 d左右恢复接近诱导麻醉前水平。但PCIA组、PCEA组相对对照组程度上要轻,且恢复快,尤其是PCEA组。结论老年癌症患者术后应该积极采用术后镇痛,方式上以PCEA方法更佳。

Objective To investigate the effect of PCIA and PCEA on T lymphocyte,NK cell of cervical cancer of old woman,to set the theoretic base for selecting reasonable methods of analgesia postoperatively.Methods 92 old patients with cervical cancer undergoing surgery were divided into three groups according to methods of postoperative analgesia：PCIA group（38 cases）,PCEA group（36 cases） and the control group（18 cases）.The venous blood was withdrawn for detecting T lymphocyte sub populations and activity of NK cell at preinduction,2h after the beginning of operation,6h,72h and 7d after operation.Results After the beginning of anesthesia and surgery,the activity of NK cell,CD4 and the ratio of CD4/CD8 of all patients decreased markedly,CD8 increased.Recovery started at 72 h after operation approaching the level of preoperation.Opposited to the control group,PCEA and PCIA group showed the lesser changes on T lymphocyte and activity of NK cell,recovered more rapidly,especially in PCEA group.Conclusion It is advised that the postoperative analgesia should be taken more enthusiastically in the patients with cancer.