术后自控镇痛不同给药途径对食管癌患者T淋巴细胞亚群及NK细胞的影响  

Effect of postoperative patient-controlled analgesia by different administration routes on T-lymphocyte subtypes and natural killer cells of blood in patients with esophageal carcinoma

作　　者：熊章荣[1] 张在空[2] 刘预[3] 牟林[1] 张智[2] 蔡华荣[2] 周洪[2] 唐延先[1] 

机构地区：[1]重庆市肿瘤研究所麻醉科,400030 [2]重庆市肿瘤研究所胸外科,400030 [3]重庆市肿瘤研究所中心实验室,400030

出　　处：《临床麻醉学杂志》2010年第12期1066-1069,共4页Journal of Clinical Anesthesiology

基　　金：重庆市卫生局科研资助项目(2008-2-279)

摘　　要：目的观察术后自控镇痛不同给药途径对食管癌患者T淋巴细胞亚群及自然杀伤(NK)细胞的影响。方法开胸食管癌根治手术患者60例,年龄50～65岁,随机分为皮下自控镇痛组(PCSA组)、PCIA组和PCEA组,每组20例。比较三组患者术后6、12、18、24及48h的VAS评分,并在麻醉前(基础值,T1)、术毕(T2)、术后第1天(T3)、第2天(T4)、第5天(T5)采集外周静脉血2ml,采用流式细胞仪检测T淋巴细胞亚群(CD3+、CD4+、CD8+、CD45+)及NK细胞的水平。结果三组患者VAS评分<3分。与T1时比较,T3～T5时三组患者CD3+、CD4+、CD8+、NK细胞均下降(P<0.05或P<0.01);T4时PCEA组患者CD3+、CD4+、CD8+水平呈上升趋势,而PCIA组和PCSA组仍呈下降趋势;T5时三组患者CD3+、CD4+、CD8+水平上升恢复,而PCIA组和PCSA组上升更为明显。CD4+/CD8+比值从T3时就开始上升恢复,T3时PCEA组达到最大值后开始下降,但较T1时明显上升(P<0.05),PCIA组和PCSA组CD4+/CD8+比值T3时呈上升趋势,T5时达到最大值,T4、T5时PCSA组CD4+/CD8+比值较T1时显著上升(P<0.05)。T4时PCIA组CD4+和CD8+水平较PCEA组降低(P<0.05)。结论 PCSA、PCIA和PCEA都适用于食管癌患者的术后镇痛,PCEA免疫功能恢复较PCIA早,PCSA与PCEA对术后免疫功能的影响无明显不同。Objective To investigate the effect of different postoperative patient-controlled analgesia on T-lymphocyte subtypes and natural killer cells of blood in esophageal cancer patients.Methods Sixty patients aged 50-65 years undergoing elective esophageal cancer surgery were randomly divided into three groups：patient controlled subcutaneous analgesia group （PCSA,n=20）,patient controlled intravenous analgesia group （PCIA,n=20）,patient controlled epidural analgesia group （PCEA,n=20）. VAS scores were measured at 6,12,18,24 and 48 h after operation respectively. Blood samples were collected before anesthesia（T1）,operation end（T2） and 1 d（T3）,2 d（T4）,5 d（T5） after surgery for determination of T-lymphocyte subsets （CD3＋,CD4＋,CD8＋,CD4＋/CD8＋,CD45＋） and NK cell by flow cytometry.Results Analgesic effect was observed in three groups,which VAS scores were within 3. Compared with baseline value,the level of CD3＋,CD4＋,CD8＋,NK cell decreased significantly at T3-T5 in three groups （P0.05 or P0.01）. From T4,the level of CD3＋,CD4＋,CD8＋ in PCEA group were uptrend,while downtrend in PCSA and PCIA groups. The level of T-lymphocyte subsets （CD3＋,CD4＋,CD8＋） in T5 were enhance in three groups,PCSA and PCIA groups were higher than PCEA. The ratio of CD4＋and CD8＋ in T4 and T5 were increase in both PCIA and PCSA groups; the ratio of CD4＋ and CD8＋ significantly increased in T4、T5 than in T1 in PCSA; the level of CD4＋and CD8＋ in T4 were lower in PCIA group compared with PCEA group （P0.05）.Conclusion PCSA,PCEA or PCIA can use analgesia for patients with esophageal cancer. Immune function of patients in PCEA group may recover earlier than in PCIA groups. There were similar immune protective effect in PCSA and PCEA groups.

关 键 词：术后自控镇痛 食管癌 T淋巴细胞亚群 NK细胞 

分 类 号：R614[医药卫生—麻醉学]