帕瑞昔布钠联合芬太尼静脉自控镇痛对胃癌根治术患者围术期的免疫保护

Perioperative Immune Protection of Postoperative Analgesia with Parecoxib Axetil and Fentanyl in Patients Undergoing Radical Gastrectomy for Gastric Cancer

目的观察帕瑞昔布钠联合芬太尼静脉自控镇痛(PCIA)对胃癌根治术患者围术期T细胞及NK细胞数量的影响。方法选择60例全身麻醉下胃癌根治术患者,按随机数字表法分为帕瑞昔布钠联合芬太尼组(A组)和单纯芬太尼组(B组),每组30例。分别于术前半小时(T0)、手术开始2h(T1)、术后24h(T2)、术后96h(T3)各时点抽取外周静脉血用流式细胞仪检测T淋巴细胞亚群(CD3+、CD4+、CD8+)及NK细胞(CD56+)的数量。镇痛效果采用VAS评分,并比较2组术后不良反应发生率。结果 2组患者CD3+、CD4+、CD4+/CD8+、NK细胞水平在T1、T2时与T0比较均有下降(均P<0.05),T2时A组CD3+、CD4+、CD4+/CD8+、NK细胞水平回升幅度大于B组(均P<0.05),T3时2组患者CD3+、CD4+、CD4+/CD8+、NK细胞水平继续有所恢复,A组恢复较快,接近T0时水平明显快于B组(P<0.05);2组CD8+细胞水平比较差异无统计学意义(P>0.05)。2组患者镇痛期间各时点VAS评分差异无统计学意义(均P>0.05)。A组不良反应发生率(16.67%)低于B组(36.67%)(P<0.05)。结论帕瑞昔布钠可减轻胃癌患者术中、术后T淋巴细胞亚群及NK细胞数量下降的程度,明显改善机体的免疫功能。

Objective To observe the effects of postoperative analgesia with parecoxib axetil and fentanyl on the numbers of T lymphocytes and NK cells during the perioperative period in patients undergoing radical gastrectomy for gastric cancer. Methods Sixty patients undergoing radical gastrectomy under general anesthesia were randomly given fentanyl alone（group B,n=30） or in combination with parecoxib group（group A,n=30）.Peripheral venous blood samples were draw at 30 minutes before operation（T0）,2 hours after the beginning of operation（T1）,24 hours after operation（T2） and 96 hours after operation（T3）.The numbers of T lymphocytes（CD3＋,CD4＋ and CD8＋） and NK cells（CD56＋） were measured by flow cytometry.Analgesic efficacy was evaluated with visual analog scale（VAS）.The incidence of postoperative adverse reactions was compared between the two groups. Results Compared with T0,the levels of CD3＋,CD4＋,CD4＋/CD8＋ and CD56＋ decreased at T1 and T2 in both groups（P＆lt;0.05）.At T2,the restoration of the levels of CD3＋,CD4＋,CD4＋/CD8＋ and CD56＋ in group A was more obvious than that in group B（P＆lt;0.05）.At T3,the levels of CD3＋,CD4＋,CD4＋/CD8＋and CD56＋ continued to be restored and the speed of restoration in group A was significantly greater than that in group B（P＆lt;0.05）.There were no significant differences in CD8＋ levels and VAS scores between the two groups at each time point（P＆gt;0.05）.The incidence of adverse reactions in group A was obviously lower than that in group B（16.67% vs 36.67%,P＆lt;0.05）. Conclusion Parecoxib axetil can improve the cellular immune function through ameliorating the decrease in T lymphocytes and NK cells in patients undergoing radical gastrectomy for gastric cancer.