术后不同镇痛方式对开胸肿瘤手术患者T淋巴细胞亚群的影响

Influence of Two Analgesic Techniques on the Immune Functions of T Lymphocyte Subsets in Patients with Thoracic Tumor Surgery Postoperatively

目的对开胸手术治疗的肿瘤患者采用不同术后镇痛方式,通过检测不同时段T_淋巴细胞亚群的变化,探讨对开胸手术肿瘤患者免疫功能的影响。方法择期全麻开胸手术肿瘤患者60例,随机分为两组,每组30例:Ⅰ组术毕采用静脉病人自控镇痛(patient controlled analgesia,PCA);Ⅱ组肋间神经阻滞+静脉PCA镇痛。两组患者分别于术前(T_0)、术毕(T_1)、术后24h(T_2)及术后48h(T_3)监测血压、心率、脉搏血氧饱和度的变化以及术后疼痛VAS评分。在上述各时点测定T_淋巴细胞亚群。结果Ⅱ组患者术毕血压、心率变化小于Ⅰ组患者(P<0.05),术毕及术后24h的疼痛VAS评分明显低于Ⅰ组患者(P<0.05);与T_0比较,在Ⅰ组中CD4+、CD4+/CD8+在T_1、T_2、T_3时间点均降低(P<0.05);在Ⅱ组中与T_0比较,CD4^+、CD4^+/CD8+在T_1、T_2、时间点均降低(P<0.05),在T_3时间点恢复至T_0水平(P>0.05)。两组患者CD8+水平在各时间点与T_0比较差异无统计学意义(P>0.05)。组间比较,T_1至T_3时点Ⅱ组的CD4^+明显高于Ⅰ组(P<0.05),T_2至T_3时点Ⅱ组的CD4+/CD8+比值明显高于Ⅰ组(P<0.05),两组患者CD8+水平在各时间点组间比较差异无统计学意义(P>0.05)。结论肋间神经阻滞+静脉PCA镇痛能有效减轻术后疼痛,减轻开胸手术肿瘤患者围术期细胞免疫功能的抑制,有利于患者T_淋巴细胞免疫功能的恢复。

Objective To evaluate the influence of two analgesic techniques on the immune functions of T lymphocyte subsets in patients undergoing thoracic tumor surgery postoperatively. Methods 60 patients who were performed opened thoracic surgery under general anesthesia were randomly divided into two groups: groupⅠ, intravenous PCA analgesia group and groupⅡ,intercostals nerve block + intravenous PCA analgesia group. The blood pressure, heart rate, pulse oxygen saturation, and postoperative pain VAS score were monitored in patients of both groups at the time of preoperative(T_0), postoperative(T_1), postoperative 24 hour(T_2) and postoperative 48 hours(T_3)respectively. Levels of T lymphocyte subsets detected at the same time point. Results: The blood pressure, heart rate of group Ⅱ changed less than that in groupⅠpostoperatively(P<0.05). Analgesia VAS score of group Ⅱat postoperative and postoperative 24 th hour was significantly lower than that in groupⅠ(P<0.05). Compared with T_0, CD4^+, CD4^+/CD8^+ at T_1, T_2 and T_3 time points significantly reduced in groupⅠ(P<0.05);In groupⅡ,CD4^+, CD4^+/CD8^+ at T_1, T_2 time points reduced significantly(P<0.05), the T_3 time recovered to T_0 level(P>0.05). There were no significant differences of CD8^+ levels in both groups at various time points compared with T_0(P>0.05). CD4^+ of groupⅡat T_1,T_2 and T_3 points was significantly higher than that of groupⅠ(P<0.05). CD4^+/CD8^+ ratio of groupⅡat T_2 and T_3 points was significantly higher than that of groupⅠ(P<0.05)。 There were no significant differences of CD8^+ levels at various time points compared between two groups(P>0.05). Conclusion Intercostals nerve block+ intravenous PCA can effectively reduce postoperative pain, reduce open thoracic surgery perioperative cellular immune function in patients with tumor suppression and beneficial to the recovery of T lymphocyte immune function in patients with thoracic tumor surgery.