引流管灌注布比卡因对乳腺癌改良根治术患者术后疼痛和免疫的影响

The influences of instillation of bupivacaine through chest and axillary drains into the wound to the postoperative pain and immunity of modified radical mastectomy

目的:探究乳腺癌改良根治术术后通过引流管灌注布比卡因对患者术后疼痛和免疫的影响。方法:收集于2014年1月至2015年6月就诊并手术的乳腺癌患者,随机分为乳腺癌改良根治术术后通过引流管灌注组(实验组)和生理盐水灌注组(对照组),并采集患者术前术后血清,分别对两组患者进行术后疼痛评分和血清免疫因子IL-1β、IL-2、IL-4、IL-5、IL-6、IL-8、IL-10、IFNγ、TNF-α的测定。结果:实验组的疼痛分数无论是在术后24小时后还是48小时后均明显小于对照组(P<0.05),差异具有统计学意义。9种免疫因子中,仅有IL-1β和IL-10的术前术后变化在实验组和对照组是有差异的,IL-1β在两组术后均趋近减少,但实验组幅度更大(P<0.05);IL-10术后在实验组增加,但在对照组减少,差异具有统计学意义(P<0.05)。结论:通过引流管灌注布比卡因对乳腺癌改良根治术患者进行术后麻醉可以减轻患者的术后疼痛、调节患者免疫、促进抑癌免疫的产生。

Objective： Studing postoperative pain and immunityof modified radical mastectomyafter using instillation of bupivacaine through chest and axillary drains into the wound. Methods： Primary breast cancer patients,were randomized to Bupivacaine（ n = 29） or control（ n = 27） groups. Postoperative pain and serum concentrations of 9 cytokines（ IL-1β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IFNγ,TNF-α） were measured. Results： There was a significant difference in 24 h and 48 h postoperative painbetween the groups（ P〈0. 05）. Patients in the bupivacainegroup showed a greater percentage decrease in postoperative compared with preoperative IL-1β（ P〈0. 05）,anda significant increase in IL-10 compared with the control group（ P〈0. 05）. Conclusion： Using instillation of bupivacaine through chest and axillary drains into the wound after the modified radical mastectomy can reduce postoperative pain and regulate the immunity to inhibit tumor.