术后镇痛对胃大部切除术后细胞因子的影响

Effects of postoperative analgesic methods on cytokines after subtotal gastrectomy

目的评价不同术后镇痛方法对胃大部切除术患者血浆中细胞因子IL-6、IL-8、TNF-α、IL-10的影响,并与传统术后镇痛方法进行比较,观察术后充分镇痛对免疫功能的影响。方法 30例ASAⅠ~Ⅱ期,择期行胃大部切除手术患者随机分为对照组（C组）,硬膜外自控镇痛组（PCEA组）,静脉自控镇痛组（PCIA组）。分别于麻醉前（T1）,术后2 h（T2）,术后8 h（T3）,术后24 h（T4）及术后48 h（T5）抽取外周血。用ELISA法检测血浆IL-6、IL-8、TNF-a和IL-10水平。结果 （1）PCEA组和PCIA组的术后镇痛VAS评分效果在T2、T3、T4、T5各时间点显著好于C组（P〈0.05）,PCEA组与PCIA组间差异无统计学意义（P〉0.05）。（2）PCEA组和PCIA组术后各时间点的细胞因子IL-6、IL-8、TNF-α和IL-10低于C组（P〈0.05）;与PCIA组比较,PCEA组的细胞因子IL-6、IL-8、TNF-α和IL-10显著降低（P〈0.05）。结论对胃大部切除术患者,PCEA组和PCIA组术后镇痛优于传统镇痛方法。PCEA组和PCIA组显著改善创伤后的免疫抑制,PCEA组更优于PCIA组。

【Objective】Compare with the tranditional methods, assess the influence of different analgesic methods on the levels of plasma cytokines IL-6 IL-8 TNF-α IL-10 after subtotal gastrectomy in patients and observe the effects of postoperative analgesic on immune function. 【Methods】Thirty ASAⅠ-Ⅱpatients who underwent subtotal gastrectomy were randomly divided into control group（C）, patient controlled epidural analgesia group（PCEA）and patient controlled intravenous analgesia group（PCIA）. Blood samples were taken before anesthesia（T1）, 2 hour after Postoperative（T2）, 8 hour after postoperative（T3）, 24 hour after postoperative（T4） and 48 hour after postoperative（T5） for determination of plasma IL-6 IL-8 TNF-α and IL-10 concentrations. 【Results】 Postoperative visual analog score was lower in PCEA group or PCIA group than that in C group at T2、T3、T4、T5 spots of time（P〈0.05）,there was not significant between PCEA group and PCIA group（P〈0.05）. Compared to C group, IL-6、 IL-8、 TNF-α and IL-10 concentrations in PCEA group and PCIA group were significantly lower at all spots of time after operation（P〈0.05）, and PCEA Group was significantly lower than PCIA group（P〈0.05）. 【Conclusion】To the patients after subtotal gastrectomy, both PCEA and PCIA were better and can much more improve immunosuppression than traditional analgesic method, but the PCEA group was excellent.