皮下自控镇痛对食管癌术后患者血清免疫球蛋白的影响

Effect of postoperative patient-controlled subcutaneous analgesia on serum immunoglobulin in patients with esophageal cancer

目的:评价皮下自控镇痛对食管癌术后患者免疫球蛋白的影响。方法:选取我院拟行食管癌根治手术的病人60例,随机分为皮下自控镇痛组(Patient controlled subcutaneous analgesia,PCSA)组,n=20、静脉自控镇痛组(Patient controlled intravenousanalgesia,PCIA)组,n=20和硬膜外自控镇痛组(Patient controlled epidural analgesia,PCEA)组,n=20。术毕以电子镇痛泵分别行皮下、静脉、硬膜外自控镇痛,行术后6、12、18、24 h及48 h的镇痛评分(Visual analogue scale,VAS);采用免疫比浊法检测麻醉前(基础值T1),术毕(T2)、术后第1天(T3)、术后第2天(T4)、术后第5天(T5)免疫球蛋白IgAI、gG和IgM的水平。结果:术前3组患者免疫球蛋白IgAI、gG和IgM差异无显著性(P>0.05)。术后3组患者IgAI、gM较术前无显著性下降(P>0.05),而IgG术毕较术前下降(P<0.05),术后1、2、5 d也较术前下降(P<0.01)。组间比较:PCSA组分别与PCIA组、PCEA组相比,免疫球蛋白IgA、IgG和IgM在各对应时间点差异无显著性(P>0.05)。结论:PCSA对食管癌术后患者血清免疫球蛋白的影响与PCIA、PCEA相同,对于食管癌术后镇痛,PCSA也是一种较好的选择。

Objective：To study the effects of postoperative patient-controlled subcutaneous analgesia on the levels of serum immunoglobulin in patients with esophageal cancer after operation.Methods：Sixty patients with esophageal cancer undergoing elective surgery were randomly divided into three groups： patient controlled subcutaneous analgesia group（PCSA group,n=20）,patient controlled intravenous analgesia group（PCIA group,n=20）,and patient controlled epidural analgesia group（PCEA group,n=20）.VAS scores were evaluated at 6,12,18,24 h and 48 h after operation respectively.Blood samples were collected before anesthesia（T1）,at the end of surgery（T2） and 1 d（T3）,2 d（T4） and 5 d（T5） after surgery for measurement of the levels of immunoglobulin.Results： There were no significantly differences of serum immunoglobulin IgA,IgG and IgM before anesthesia（T1） in each groups.After surgery,serum IgA,IgM levels were not significantly decreased than before anesthesia（P0.05）.However,serum IgG levels were significantly decreased at the end of surgery（T2） in the three groups（P0.05） and at 1,2 d and 5 d after surgery in the three groups（P0.01）.There were no significant differences in serum IgA,IgG and IgM levels in PCSA and PCIA and PCEA groups at any time point after operation（P0.05）.Conclusion：There is similitude among PCSA and PCIA and PCEA groups on serum immunoglobulin IgA,IgG and IgM.PCSA is a good choice for patients with esophageal cancer surgery.