术后不同镇痛方式对肺癌根治术患者术后免疫功能的影响

The effect of different analgesia methods on postoperative cellular immune function in patients with radical resection of lung cancer

目的 探讨两种不同术后镇痛方式对肺癌根治术患者术后免疫功能的影响.方法 50例择期全身麻醉下行肺癌根治术患者根据术后镇痛方式不同分为两组,A组25例,采用单纯吗啡硬膜外自控镇痛（PCEA）;B组25例,采用帕瑞考昔超前镇痛复合PCEA.于麻醉前、术中2h、术后24 h、术后48 h4个时间点采用流式细胞仪检测T淋巴细胞亚群（CD4^＋、CD8^＋）及自然杀伤细胞（NK细胞）水平.结果 两组患者麻醉前CD4^＋、CD8^＋T淋巴细胞及NK细胞水平比较差异无统计学意义（P＞0.05）；两组患者术中2h及术后24、48 h CD4^＋、CD4^＋/CD8^＋水平均较麻醉前明显降低（A组：CD4^＋：0.252±0.035、0.227±0.025、0.248±0.028比0.310±0.032,CD4^＋/CD8^＋：1.2±0.1、1.0±0.1、1.1±0.2比1.5±0.2;B组：CD4^＋：0.265土0.033、0.263士0.028、0.264士0.031比0.312±0.035,CD4^＋/CD8^＋：1.3±0.2、1.2±0.1、1.2±0.1比1.4±0.1）（P＜0.05）；与A组比较,B组CD4^＋、CD4^＋/CD8^＋在术后24、48 h下降幅度较小,差异有统计学意义（P＜0.05）；与麻醉前比较,两组术后24、48 h NK细胞水平均显著下降（0.112±0.019、0.113±0.016比0.126±0.019,0.117±0.016、0.120±0.018比0.127±0.021） （P＜0.05）,B组NK细胞水平在术后24、48 h均明显高于A组,差异有统计学意义（P＜0.05）.结论 帕瑞考昔复合吗啡PCEA可以通过降低CD4^＋T淋巴细胞以及NK细胞数量的下降幅度,减轻肿瘤患者免疫抑制.

Objective To study the effect of different analgesia methods on postoperative cellular immune function in patients with radical resection of lung cancer.Methods Fifty patients undergoing selective radical resection of lung cancer were randomly divided into two groups.Group A （25 patients） was given morphine patient-controlled epidural analgesia（PCEA） and group B （25 patients） was given preemptive analgesia with parecoxib combined with morphine PCEA.T-lymphocyte subsets （CD4^＋,CD8^＋）and natural killer cell （NK cell） were measured by flow cytometry at preanesthesia,2 h intraoperative,24,48 h postoperative.Results The level of CD4^＋,CD8^＋ and NK cell in two groups at preanesthesia had no significant difference （P 〉0.05）.The level of CD4^＋ and CD4^＋/CD8^＋ in two groups at 2 h intraoperative,24,48 h postoperative were significantly lower compared with preanesthesia （group A：CD4^＋：0.252 ± 0.035,0.227 ±0.025,0.248 ± 0.028 vs.0.310 ± 0.032,CD4^＋/CD8^＋：1.2 ± 0.1,1.0 ± 0.1,1.1 ± 0.2 vs.1.5 ± 0.2;group B：CD4^＋：0.265 ± 0.033,0.263 ± 0.028,0.264 ± 0.031 vs.0.312 ± 0.035,CD4^＋/CD8^＋：1.3 ± 0.2,1.2 ± 0.1,1.2 ± 0.1 vs.1.4 ± 0.1）（P 〈 0.05）.Compared with group A,the range of descend of CD4^＋ and CD4^＋/CD8^＋ in group B was significantly less at 24,48 h postoperative （P 〈 0.05）.The level of NK cell in two groups at 24,48 h postoperative was significantly lower than preanesthesia（O.112 ＋ 0.019,0.113 ＋ 0.016 vs.0.126 ＋ 0.019 and 0.117 ＋0.016,0.120 ＋0.018 vs.0.127 ＋ 0.021） （P 〈0.05）.The level of NK cell in group B at 24,48 h postoperative was significantly higher than that in group A （P 〈 0.05）.Conclusion Parecoxib sodium preemptive analgesia combined with morphine PCEA may reduce immune depress in tumor palients by lowering the range of descend of CD4^＋ and NK cell.