地佐辛静脉镇痛对肺叶切除术后CD4^＋和CD8^＋T淋巴细胞的影响

The effect of analgesia with dezocine on CD4^＋and CD8^＋T lymphocytes in patients after pulmonary lobectomy

目的观察地佐辛静脉镇痛对肺叶切除术后CD4^＋、CD8^＋T淋巴细胞的影响。方法选取70例拟行开胸肺叶切除术的临床早期非小细胞肺癌患者，按随机数字表法分为对照组和地佐辛组，每组35例。地佐辛组术后经患者自控镇痛泵给予0．5mg／ml地佐辛，对照组术后经患者自控镇痛泵给予0．9％氯化钠。采集患者麻醉诱导前、术后4h、术后24h和术后48h血标本，测定外周血淋巴细胞计数及淋巴细胞中CD4^＋T淋巴细胞、CD8^＋T淋巴细胞、自然杀伤细胞（NK细胞）比例的变化。结果术后24h，对照组和地佐辛组患者外周血淋巴细胞计数和NK细胞比例分别为（1．08±0．21）×10^9／L、0．1414±0．0218和（1．14±0．28）×10^9／L、0．1249±0．0276，均较麻醉诱导前的（1．71±0．33）×10^9/L、0．1909±0．0228和（1．69±0．28）×10^9／L、0．1986±0．0275明显降低，差异有统计学意义（P〈0．05）。与对照组比较，地佐辛组术后24hCD4^＋T淋巴细胞明显升高（0．3556±0．0311比0．2735±0．0294），差异有统计学意义（P〈0．05）。两组不同时点CD8^＋T淋巴细胞比较差异无统计学意义（P〉0．05）。结论地佐辛静脉镇痛可改善肺叶切除术后的免疫抑制。

Objective To investigate the effect of analgesia with dezocine on CD4^＋and CD8^＋T lymphocytes in patients after pulmonary lobectomy. Methods Seventy patients with early non-small-cell lung cancer were selected, and they were scheduled the pulmonary lobectomy. The patients were divided into control group and dezocine group by random digits table method with 35 cases each. The patients in dezocine group were given 0.5 mg/ml dezocine by patient-controlled analgesia （PCA） pump, and the patients in control group were given 0.9% sodium chloride by PCA pump. The peripheral blood lymphocytes count and percentages of CD4^＋T lymphocytes, CD8^＋T lymphocytes, natural killer cell （NK cell） before anesthesia induction and 4, 24, 48 h after operation were detected. Results In control group, the peripheral blood lymphocytes count and NK cell 24 h after operation were （1.08 ± 0.21） × 10^9/L and 0.141 4 ± 0.021 8, which before anesthesia induction were （1.71 ± 0.33） × 10^9/L and 0.190 9 ± 0.022 8, and there were statistical differences （P 〈 0.05）. In dezocine group, the peripheral blood lymphocytes count and NK cell 24 h after operation were （1.14 _±0.28） × 10^9/L and 0.124 9 ±0.027 6, which before anesthesia induction were （1.69 ± 0.28）× 10^9/L and 0.198 6 ± 0.027 5, and there were statistical differences （P 〈 0.05）. The CD4^＋T lymphocytes 24 h after operation in dezocine group was significantly higher than that in control group （0.355 6 ± 0.031 1 vs. 0.273 5 ± 0.029 4）, and there was statistical difference （P 〈 0.05）. There was no statistical difference in CD8^＋T lymphocytes between the 2 groups （P 〉 0.05）. Conclusion Analgesia with dezocine can notably improve immunosuppression in patients after pulmonary lobectomy.