硬膜外镇痛对静吸复合全麻肺癌手术病人免疫功能的影响

EFFECT OF EPIDURAL ANALGESIA ON THE CHANGES OF LYMPHOCYTE SUBSET,NATURAL KILLER CELL ACTIVITY IN PATIENTS UNDERGOING COMBINED ANESTHESIA

探讨围术期硬膜外镇痛对静吸复合全麻肺癌手术病人免疫功能的影响。方法 :将 38例肺癌手术患者 ,随机分为实验组和对照组 ,两组均采用相同的全麻药物。实验组病人入室后于 Th5～ 6 置入硬膜外导管 ,并注入 1.6 %利多卡因 5～ 8ml,然后每隔 1h注入 5 m l,直至手术结束后以 0 .2 %布比卡因和 6 m g/ L 丁丙喏啡混合液行 PCA镇痛 ,至术后 72 h。分别于麻醉前、麻醉后 1h、术后 2 4h、术后 72 h、术后 1周 ,采静脉血检测淋巴细胞亚群及 NK细胞活性。结果 :对照组 CD3、CD4降低程度明显大于麻醉前及实验组。术中两组的 NK细胞活性均出现一过性增高随后明显降低。结论 :硬膜外镇痛可减轻静吸复合麻醉对肺癌病人免疫功能的抑制。

Objective:To investigate the effect of epidural analgesia on the changes of lymphocyte subset,natural killer (NK) cell activity in patients undergoing combined anesthesia Methods:Thirty eight lung cancer patients were randomly divided into test group (n=20) and control group (n=18) The patients in test group were given 5~8 ml solution of 1 6% lidocaine epidurally before anesthesia and 5 ml for each one hour after combined anesthesia until the finish of operation,and then administered with solution of 0 2% bupivacaine and 6 mg/L buprenorphine hydrochloride at loading dose of 3~5 ml,continuos infusion rate of 2~3 ml/h and PCA bolus doses of 2~3 ml after operation The patients in control group were not administrated epidurally as above.The lymphocyte subset and NK cell activity were measured before anesthesia,1 h,24 h,72 h and one week after anesthesia Results:The level of CD 3,CD 4 were decreased in both group and more significantly in control group There were significant difference between two groups 24 h after anesthesia The ratio of CD 4/CD 8 were decreased in both groups 24 h after anesthesia The NK cell activity increased 1 h and then decreased 24 h after anesthesia in both groups The level of CD 3,CD 4,NK cell activity recovered to the baseline 72 h after anesthesia in test group and lower than normal in control group Conclusion:The method of epidural analgesia can release the immunosupression of lymphocyte subset and NK cell activity