帕瑞昔布钠超前镇痛对食管癌手术患者外周T淋巴细胞亚群分化的影响

Effects of preemptive analgesia of parecoxib sodium on T lymphocyte subsets in patients with esophageal carcinoma surgery

目的:探讨帕瑞昔布钠超前镇痛对食管癌患者围手术期细胞免疫功能的影响。方法:50例择期全麻下行食管癌根治术患者随机分为2组,P组患者麻醉诱导前30 min静脉注射帕瑞昔布钠40 mg(5 ml);C组麻醉诱导前30 min静脉注射0.9%氯化钠注射液5 ml,2组患者术后均予以患者自控硬膜外镇痛。于麻醉前、手术中2 h及术后24 h、48 h等4个时间点用流式细胞仪检测T淋巴细胞亚群(CD4+、CD8+)及辅助性T淋巴细胞(Th细胞)水平。结果:2组患者麻醉前CD4+、CD8+T淋巴细胞、Th1、Th2细胞水平和Th1/Th2比值差异均无统计学意义(P>0.05);2组患者CD4+、CD4+/CD8+水平于术中2 h、术毕24、48 h均较麻醉前降低(P<0.01);与C组比较,P组CD4+在术毕24 h和48 h、CD4+/CD8+在术中2 h、术毕24、48 h均高于C组(P<0.05～P<0.01);与麻醉前比较,2组术毕24、48 h Th1与Th1/Th2比值均较麻醉前下降(P<0.05～P<0.01),而Th2则均升高(P<0.05和P<0.01);P组Th1/Th2比值在术毕24、48 h均明显高于C组(P<0.05和P<0.01)。结论:帕瑞昔布钠超前镇痛可以通过降低CD4+T淋巴细胞数量下降幅度与抑制Th1/Th2平衡趋向于Th2免疫反应的方式,减轻肿瘤患者免疫抑制。

Objective： To investigate the effects of preemptive analgesia of parecoxib sodium on cellular immune function in perioperative period of patients with esophageal carcinoma. Methods： Fifty patients scheduled for esophageal carcinoma surgery were randomly divided into P and C group. Group P and C were injected with 5 ml of parecoxib sodium （ 40 mg） and normal saline at 30 minutes before anesthesia induction, respectively. Two groups were treated with patient controlled epidural analgesia after operation. The levels of T-lymphocyte subsets（ CD4 ＋ and CD8 ＋ ） and T helper lymphocytes differetiation were measured by flow cytometry before anesthesia induction, at 2 hours after the start of operation and 24 and 48 hours after operation. Results ： The differences of the levels of CD4 ＋ ＆ CD8 ＋ ,Th1 ＆ Th2 and ratio of Thl and Th2 in two groups were not statistical significance before anesthesia（P 〉 0.05 ）. Compared with before anesthesia,the levels of CD4 ＋ and CD4 ＋/CD8 ＋ in two groups decreased at 2 hours after the start of operation and 24 and 48 hours after operation（ P 〈 0.01 ）. Compared with group C, the levels of CD4 ＋ at 24 and 48 hours after operation and CD4 ＋/CD8 ＋ at 2 hours after the start of operation and 24 and 48 hours after operation in group P were higher（P 〈0.05 to P 〈0.01 ）. Compared with before anesthesia,the levels of Thl and ratio of Thl and Th2 in two groups decreased at 24 and 48 hours after operation （ P 〈 0.05 to P 〈 0.01 ） ,while the Th2 level significantly increased（ P 〈 0.05 and P 〈 0.01 ）. The ratio of Thl and Th2 in group P was significantly higher than that in group C at 24 and 48 hours after operation （ P 〈 0.05 and P 〈 0.01 ）. Conclusions ： Preemptive analgesia of parecoxib sodium may alleviate immunosuppression in tumor patients by the way of lowering the decreasing index of CD4 ＋ T lymphocyte,inhibiting the tendency of Th1/Th2 balance and activating Th2 immune response.