摘要
目的研究硬膜外自控镇痛对下肢骨肿瘤患者术后下肢微循环及T淋巴细胞亚群的影响。方法选取下肢骨肿瘤行择期手术患者108例,参考随机数字表法,按照1∶1比例将纳入者随机分为观察组和对照组,各54例。两组患者采用同样的麻醉方法,术后镇痛观察组采用硬膜外自控镇痛、对照组采用静脉自控镇痛。且于术后4 h、24 h、48 h观察两组患者疼痛程度,麻醉前30 min、切皮后2 h、术后4 h、24 h、48 h免疫功能指标(CD4^+、CD8^+、计算CD4^+/CD8^+比值)以及术前、术后48 h踝肱指数(ABI)、足背动脉血流量;术后首次排便、排气时间。结果术后4 h、48 h,观察组VAS评分与对照组比较,差异无统计学意义(P>0.05)。术后24 h,观察组VAS评分低于对照组,差异有统计学意义(P<0.05)。术后48 h,观察组ABI、足背动脉血流量高于对照组,差异均有统计学意义,(P<0.05)。麻醉前30 min、切皮后2 h,观察组CD4^+、CD4^+/CD8^+比值与对照组比较,差异无统计学意义(P>0.05)。术后4 h、24 h、48 h,CD4^+、CD4^+/CD8^+比值高于对照组,差异有统计学意义(P<0.05)。结论硬膜外自控镇痛能减轻下肢骨肿瘤患者术后疼痛,降低下肢微循环异常风险、减轻细胞免疫抑制,有助于保证患者平稳渡过手术危险期、促进其早日康复。且凭借其可控性及灵活性强等优势,值得推广。
Objective To study the effect of epidural analgesia on lower extremity microcirculation and T lymphocyte subsets in patients with lower extremity bone tumor. Methods 108 patients undergoing elective surgery were selected. The random number table method was randomly divided into the observation group and the control group according to the ratio of 1∶ 1.The 2 groups of patients using the same anesthesia,postoperative analgesia of the observation group using epidural analgesia,the control group using intravenous analgesia.（ CD4~＋,CD8~＋,CD4 ~＋/CD8~＋ ratio） and preoperative,intraperitoneal and postoperative levels of the 2 groups were observed at 4 h,24 h and 48 h after operation. The levels of CD4~＋,CD8~＋,CD4 ~＋/CD8~＋ 48 hours after ankle brachial index（ ABI）,dorsalis pedis artery blood flow;postoperative defecation,exhaust time. Results There was no significant difference between the observation group and the control group at 4 hours and 48 hours after operation（ P〈0. 05）. After 24 hours,the VAS score of the observation group was lower than that of the control group,the difference was statistically significant（ P〈0. 05）. At 48 h after operation,the blood flow of ABI and dorsalis pedis artery in the observation group was higher than that of the control group,the difference was statistically significant（ P〈0. 05）. There was no significant difference in CD4~＋,CD4~＋/CD8~＋ ratio between the 2 groups before and after implantation（ P〉0. 05）. The ratio of CD4~＋,CD4~＋/CD8~＋ was higher than that of the control group at 4 h,24 h and 48 h after operation（ P〈0. 05）. Conclusion Epidural analgesia can reduce the postoperative pain,reduce the risk of lower extremity microcirculation and reduce the immunosuppression of the patients with lower extremity bone tumor,and help to ensure the smooth survival of the patients and promote the early recovery. And by virtue of its controllability and flexibility and other advantages,it is worth promoting.
作者
萧国凤
吕浩
XIAO Guofeng;LV Hao(Navy General Hospital,Beijing,100048)
出处
《实用癌症杂志》
2018年第5期840-843,847,共5页
The Practical Journal of Cancer
关键词
下肢
骨肿瘤
硬膜外自控镇痛
循环
T淋巴细胞
Lower extremity
Bone tumor
Epidural controlled analgesia
Circulation
T lymphocytes
