多模式的镇痛方法对结肠癌根治术患者的免疫功能的影响

Effects of multimodal analgesia on immune function in patients treated with radical resection of colon cancer

目的探讨不同模式的镇痛方法对结肠癌根治术患者的免疫功能的影响。方法选择150例结肠癌根治患者,ASAⅠ～Ⅱ级,随机分为5组,每组30例,Ⅰ组：空白组,不做任何术后镇痛;Ⅱ组：PCIA;Ⅲ组：PCEA;Ⅳ组：术毕切口注射0.5%的罗哌卡因20 ml＋PCIA;Ⅴ组：术毕切口注射0.5%的罗哌卡因20 ml＋PCEA。分别在麻醉前（T1）、术后1 h（T2）、24 h（T3）、48 h（T4）、72 h（T5）、120 h（T6）、168 h（T7）抽取外周静脉血测量各组患者的T细胞（CD3＋、CD4＋、CD8＋）、NK、IL-2、IL-6、TNF-α、C3、C4和CRP的含量并作统计学差异比较和术后VAS疼痛评分。结果与Ⅰ组相比,Ⅱ、Ⅲ、Ⅳ和Ⅴ组T2～T5疼痛明显减轻（P〈0.05）,其中Ⅴ组的镇痛效果最佳;Ⅱ、Ⅲ、Ⅳ和Ⅴ组在T2～T5的CD3＋、CD4＋、NK和IL-2含量均明显升高,CD8＋、IL-6、TNF-α、C3、C4和CRP的含量明显下降（P〈0.05）,Ⅴ组的免疫参数在各时点更接近T1水平。结论术毕切口注射0.5%的罗哌卡因20 ml＋PCEA方案是结肠癌根治术后最佳镇痛方法,最大程度减轻患者的疼痛和应激反应,有利于患者免疫功能的恢复。

To evaluate the effect of different analgesia on immune function in patients treated with radicalresection of colon cancer. Total of 150 colon cancer patients at ASA I ～ II were recruited and randomly divided into5 groups（n=30）： group I（blank group, no postoperative analgesia）, group II（PCIA）, group III（PCEA）, group IV（0.5% ropivacaine 20 ml was injected in postoperative incision ＋PCIA）, and group V（0.5% ropivacaine 20 ml wasinjected in postoperative incision ＋PCEA）. Peripheral blood was abstracted to measure T cells（CD3＋, CD4＋, CD8＋）,NK, IL-2, IL-6, TNF-α, C3, C4 and CRP levels before anesthesia（T1） and in 1 h（T2）, 24 h（T3）, 48 h（T4）, 72 h（T5）,120 h（T6）, 168 h（T7） after operation respectively. Then these parameters were compared statistically and VAS painscore was evaluated post-operation. Compared with group I, the pain in T2～T5of group II, III, IV and V wassignificantly reduced（P〈0.05）, and group V showed one of the best analgesic effect; the levels of CD3＋, CD4＋, NKand IL-2 were significantly increased but CD8＋IL-6, TNF-a, C3, C4 or CRP were significantly decreased in T2～T5of group II, III, IV and V（P〈0.05）, and the immune parameter at each time point of group V was closer to the level ofT1. Thus, we concluded that the best method for analgesia is 0.5% ropivacaine 20 ml injection in postoperativeincision ＋PCEA after the operation of radical resection of colon cancer, which alleviates the patient＇s pain and stressresponses in greatest degree and promotes the recovery of immune function in patients.