恶性肿瘤患者术后硬膜外自控镇痛对IL-2和IL-6的影响  

Influence of postoperaive pcea on IL-2 and IL-6 in patients with cancer

作　　者：王建荔[1] 张行[1] 阮林[1] 彭丹晖[1] 顾永辉[1] 林飞[1] 蒋英[1] 

机构地区：[1]广西医科大学附属肿瘤医院麻醉科,广西南宁530021

出　　处：《现代肿瘤医学》2009年第7期1340-1342,共3页Journal of Modern Oncology

摘　　要：目的:研究恶性肿瘤患者术后硬膜外自控镇痛对血清白细胞介素-2(IL-2)、白细胞介素-6(IL-6)的影响。方法:选择拟行妇科恶性肿瘤根治术的患者30例,分为2组(每组n=15):丁丙诺啡组(B组)与芬太尼组(F组)。术毕均行硬膜外自控镇痛(PCEA),镇痛时间为48h。两组分别于术前2h,术后2h、1d、3d和5d各记录一次。并采集外周静脉血,采用酶联免疫吸附法(ELISA法)检测血清中IL-2、IL-6水平。评估术后病人镇痛4个时点的视觉模拟评分(VAS),记录病人有无不良反应。结果:两组术后硬膜外自控镇痛各观察时点的IL-2水平与术前相比无明显变化(P>0.05),组间各观察时点比较无统计学差异(P>0.05);两组IL-6水平术后2h与术前相比显著升高(P<0.01),术后1d和3d与术后2h相比逐渐下降(P<0.01),仍高于术前水平(P<0.05),术后第5d基本恢复至术前水平(P>0.05),两组间相应时点比较差异无统计学意义(P>0.05)。硬膜外自控镇痛可有较好的镇痛效果,不良反应少。结论:恶性肿瘤患者术后硬膜外自控镇痛可有效消除术后疼痛,对术后患者血清中IL-2水平无明显影响,能抑制IL-6水平的明显升高。提示丁丙诺啡与芬太尼用于妇科恶性肿瘤患者术后镇痛,在一定程度上维持体内细胞因子及内环境的稳定,能减轻机体应激反应,减轻术后免疫功能抑制,利于患者术后康复。Objective：To study the clinical effects of patient -controlled epidural analgesia（PCEA） on postoperative pain and the serum interleukins level（ IL- 2 and IL- 6） in patients with cancer. Methods：Thirty ASA Ⅰ - Ⅱ patients aged 20 - 60 with gynecological malignancy undergoing radical correction were selected and randomly divided into two groups（ 15 patients each group） ：buprenorphine group（group B） and fentanyl group（group F）. PCEA were administrated after surgery continued for 48h. Blood samples were taken from peripheral vein 2h before anesthesia, 1d,3d and 5d after surgery for determination of serum IL- 2 and IL -6 level using enzyme -linked immunosorbent assay（ELISA）. The analgesic effect was assessed by VAS score. The incidence of side effects was recorded. Results： The postoperative analgesia was good in both groups. Compared with that before anesthesia （base line）, there was no significant difference in IL - 2 （ P 〉 0.05 ） and no difference between the two groups （ P 〉 0.05 ）. IL - 6 level in both group noticeably raised 2h after surgery compared with base line （P 〈 0. 01 ） , gradually decreased 1 d and 3d after analgesia comparing with 2h after surgery（P 〈0.01 ） ,but was higher than base line（P 〈0.05） ,on the 5th day after surgery essentially recovered to base line （P 〉 0.05） ;But there was no difference between the two groups （P 〉 0.05）. Conclusion： PCEA with eliminate postoperative pain on patient with cancer undergoing radical correction. The two drugs have little effect on serum IL -2 level, but decrease the elevated IL -6 level. Buprenorphine and fentanyl used in patients with gynecological malignancy may alleviate the stress response, attenuate immunosuppression and expedite recovery after surgery.

关 键 词：恶性肿瘤 硬膜外自控镇痛 白细胞介素-2 白细胞介素-6 丁丙诺啡 芬太尼 

分 类 号：R730.3[医药卫生—肿瘤]