摘要
目的:探讨硬膜外病人自控镇痛(PCEA)对术后患者免疫功能的影响。方法选择70例早期消化道肿瘤患者,随机分为两组(PCEA组,对照组,n = 35)。麻醉均选择全麻加连续硬膜外麻醉。检测术前、术后1天、术后3天、术后7天血CD3^+、CD4^+、CD8^+、CD4^+/CD8^+、IL-2、IL-6水平。结果:术后1天两组CD3^+较术前均有下降(P<0.01),且两组间有显著性差异(P<0.05)。两组CD4^+在术后1天、第3天均较术前显著降低(P<O.01～0.05),以术后第1天最为明显;对照组CD4^+下降较PCEA组更为明显(P<0.05)。PCEA组术后1天CD4^+/CD8^+较术前有显著降低(P<0.05),而对照组为极显著降低(P<0.01)。两组IL-2在术后1天、3天较术前均显著降低(P<0.05),两组间各无明显差异。两组IL-6术后1天、3天均明显升高(P<0.01～0.05),而对照组升高更明显(P<0.01),两组均术后7天基本恢复正常。结论:术后患者免疫功能受到抑制,PCEA可减轻患者术后的免疫抑制。
Objective: To investigate the immunomodulatory effects of patient - controlled epidural anal-gesia(PCEA). Method: The study enrolled 70 elective patients with digestive system tumor who received abdominal surgery. All patients received general anesthesia combined with epidural anesthesia. Patients were randomly and evenly allocated to two groups; PCEA group undergoing PCEA, and control group undergoing conventional postoperative analgesia (e. g. , i. m. analgesic). Venous blood samples for measurement of CD3 + ,CD4+ ,CD4 + /CD8 + ,IL-2,IL-6 were drawn prior to the start and 1 day, 3 days and 7 days after operation in the morning. Results: CD3 + declined significantly(P <0. 01 ) in both groups on the first day and there was an even more significant decrease in the control group (P <0. 05). Significant declination of CD4 + was also found in two groups on the first and third postoperative day (P <0. 01 - P < 0.05) and it was the lowest on the first day. The change was more obvious in control groups. CD4+/ CD8+ lowed significantly in PCEA group(P < 0. 05 ) and most significantly in controlled group(P<0. 01 ). IL-2 decreased in both groups on the first and third postoperative day, and no significant difference had been found between two groups. IL-6 significantly increased in both groups (P <0. 01 -P<0.05) on the first and third day, with the control group changed more dramatically (P<0.01). IL-6 recovered to normal level on the seventh postoperative day. Conclusion: The immunity of postoperative patients are inhibited and PCEA can attenuate this harmful effect.
出处
《中国疼痛医学杂志》
CAS
CSCD
2003年第2期92-95,共4页
Chinese Journal of Pain Medicine
关键词
免疫
镇痛
硬膜外
Immunity
Analgesia
Epidural
