摘要
肺癌患者的细胞免疫、体液免疫、红细胞免疫等状况较正常人均存在着不同程度的低下。目前早中期患者肺癌的首选治疗方式仍然是手术切除治疗。虽然切除肿瘤可以逐渐消除瘤体本身造成的免疫抑制,但手术创伤引发的机体应激反应、神经内分泌变化、疼痛的刺激以及麻醉药物的使用在术后一段时间内反而会加重免疫抑制。因此针对围术期内多个治疗环节加以改进,可以有助于患者术后免疫功能的恢复,减少肿瘤复发、转移的几率。具体措施包括术前给予参芪扶正注射液、番茄红素、胸腺肽等药物以及预先给予适当的心理疏导以提升免疫力;术中更多的运用微创胸腔镜技术并在全身麻醉时联用硬膜外麻醉;围术期采用多模式联合镇痛,术前给予氟比洛芬酯等非甾体类抗炎药物开展超前镇痛,术后给予静脉持续自控镇痛时辅用地佐辛等药物或与肋间神经阻滞相结合,或改用硬膜外自控镇痛、自控椎旁神经阻滞等方法镇痛;此外术后建议给予患者早期营养支持,尽量减少不必要的输血,需要输血时使用辐照成分输血。
The cellular immunity,humoral immunity and erythrocyte immunity of lung cancer patients are all lower in different degrees than normal.At present,the first choice of treatment for lung cancer in early and middle stage patients is still surgical resection.Although resection of the tumor can alleviate the immunosuppression caused by the tumor itself,the stress response caused by surgical trauma,neuroendocrine changes,pain stimulation and the use of narcotic drugs will aggravate the immunosuppression in a period of time after surgery.Therefore,the improvement of multiple treatment links during the perioperative period can help to promote the recovery of postoperative immune function and reduce the probability of tumor recurrence and metastasis.Specific measures include giving Shenqi Fuzheng Injection,lycopene,thymosin and other drugs before operation and giving appropriate psychological counseling in advance to enhance immunity.During the operation,minimally invasive video-assisted thoracoscopic techniques more frequently is used and epidural anesthesia and general anesthesia are combined.In the perioperative period,multiple modes of combined analgesia are used.Preemptive analgesia with non-steroidal anti-inflammatory drugs such as flurbiprofen axetil is used before operation.After surgery,continuous patient-controlled intravenous analgesia with adjuvant drugs such as dezocine or combined with intercostal nerve block is used,or other methods such as patient-controlled epidural analgesia and patient-controlled paraspinal nerve block for analgesia are used.Besides,patients shoule receive early postoperative nutritional support.Unnecessary blood transfusion is minimized,and irradiated component transfusion can be used when blood transfusion is really needed.
作者
杨洋
隋铁泉
Yang Yang;Sui Tiequan(Department of Thoracic Surgery,Tianjin Fifth Central Hospital,Tianjin 300450,China)
出处
《现代肿瘤医学》
CAS
2020年第3期512-516,共5页
Journal of Modern Oncology
关键词
肺癌
围术期
免疫保护
lung cancer
perioperative period
immune protection
