肺癌患者术后不同镇痛模式对免疫功能的影响

Effects of different postoperative analgesia model on immune function in patient with lung neoplasm

目的观察不同镇痛模式对肺癌患者术后细胞免疫功能的影响。方法将进行术后镇痛的肺癌患者98例随机分为:A组间断肌注哌替啶;B组术毕切口注射罗哌卡因后安放导管继续泵注罗哌卡因;C组采用芬太尼加静脉镇痛(PCIA);D组行自控硬膜外镇痛(PCEA);E组行PCIA。分别于麻醉前,术毕,术后24、48、168 h采血测定CD4+、CD8+、NK细胞活性及TNF-α、IL-1β含量及VAS评分。结果 (1)术后各组CD4+、NK细胞活性下降,CD8+活性升高;(2)TNF-αI、L-1β含量各组均升高;(3)A组患者VAS评分高于其他组。结论肺癌患者术后行有效镇痛可改善免疫抑制,通过外周神经机制镇痛的模式可能更为适宜。

Objective To observe the effects of cellular immune function in patients with lung cancer by postoperative analgesia.Methods Ninety eight patients with Lung cancer were randomLy divided into five groups：patients were postoperative analgesia by intramuscular pethidine interruptably（group A）,injection ropivacaine in incisal opening and continued to release ropivacaine with a special catheter in incision（group B）,or venous injection fentanyl（group C）,PCEA by ropivacaine and fentanyl（group D）,PCIA by fentanyl（group E）.At these time points：preanesthesia,operation end,and 24,48,168 h after operation,CD4^＋,CD8^＋,NK cell of blood samples were detected,and Serum TNFα and IL-1β were measured.VAS scores were measured too.Results At postoperative time points,CD4^＋,NK cell were obviously down-regulated,and CD8^＋ was markedly increased.Serum TNFα,IL-1β levels increased markedly in all groups after operation and VAS scores in group I was increased compared with others.Conclusion Postoperative active analgesia was protected immune function of patients,and maybe by peripheral neuromechanism was better beneficial.