皮下自控镇痛对食管癌术后病人血清细胞因子的影响  

EFFECT OF POSTOPERATIVE PATIENT-CONTROLLED SUBCUTANEOUS ANALGESIA ON SERUM CYTOKINES IN PATIENTS WITH ESOPHAGEAL CANCER

作　　者：熊章荣[1] 张在空[2] 刘兴明[3] 刘预[3] 刘怀清 唐延先[1] 

机构地区：[1]重庆市肿瘤研究所麻醉科,重庆400030 [2]重庆市肿瘤研究所胸外科,重庆400030 [3]重庆市肿瘤研究所中心实验室,重庆400030 [4]重庆市南桐总医院麻醉科,重庆400030

出　　处：《中国疼痛医学杂志》2010年第6期334-338,共5页Chinese Journal of Pain Medicine

基　　金：重庆市卫生局资助课题(2008-2-279)

摘　　要：目的:评价皮下自控镇痛对食管癌术后病人细胞因子的影响。方法:选取我院拟行食管癌根治手术的病人60例,随机分为皮下自控镇痛组(PCSA组,n=20)、静脉自控镇痛组(PCIA组,n=20)和硬膜外自控镇痛组(PCEA组,n=20)。术毕以电子镇痛泵分别行皮下、静脉、硬膜外自控镇痛,行术后6、12、18、24及48h的镇痛评分(VAS评分);采用放免法检测麻醉前(T1)、术毕(T2)、术后第1天(T3)、术后第2天(T4)、术后第5天(T5)血清白介素-2(IL-2)、白介素-6(IL-6)的水平及外周血白细胞(WBC)计数。结果:三组术后VAS评分均在3分以下,PCSA组和PCIA组各时点差异无显著性(P>0.05),与PCEA组比较,PCSA组和PCIA组术后各时点VAS评分均升高(P<0.05)。术前三组血清IL-2、IL-6水平及WBC差异无显著性(P>0.05)。三组术后各时点与术前比较:三组病人血清IL-2在术后有明显降低(P<0.05),而血清IL-6水平及WBC升高(P<0.05),IL-6于术后第1天(T3)达峰值,术后第5天(T5)均维持在较高水平。组间比较:PCSA组与PCIA组之间在各时点血清IL-2、IL-6水平差异无显著性(P>0.05),与PCEA组比较,PCSA组和PCIA组术后IL-6在T3时点明显升高(P<0.05)。结论:PCSA对于食管癌病人血清IL-2、IL-6水平及WBC的影响与PCIA相同,PCEA较PCSA、PCIA更能有效地降低食管癌术后病人血清IL-6水平升高程度。Objective：To study the effects of postoperative patient-controlled subcutaneous analgesia on the levels of serum interleukin-2（IL-2）and interleukin-6（IL-6） in patients with esophageal cancer after operation.Methods： 60 patients with esophageal cancer undergoing elective 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 evaluated at 6,12,18,24 and 48h after operation respectively.Blood samples were collected before anesthesia（T1）,at the end of surgery（T2） and 1（T3）,2（T4）,5d（T5） after surgery for measurement of the levels of IL-2,IL-6 and white blood cell（WBC）.Results： VAS scores were less than 3 in each group,which no significance between PCSA and PCIA groups（P〉0.05）,but that in PCSA or in PCIA group was significantly higher than that in PCEA group at each time point（P〈0.05）.There were no significance on serum IL-2,IL-6 levels and WBC before anesthesia（T1） in each group and serum IL-2 levels were significantly decreased at the end of surgery（T2） in the three groups.（P〈0.05）,serum IL-6 levels and WBC were significantly increased at 1,2,5d after surgery in the three groups（P〈0.05）,serum IL-6 reached a peak level 1day after surgery（T3）,that were maintained at a high level till 5 days after surgery（T5）.There were no significant differences in serum IL-2 、IL-6 levels and WBC in PCSA and PCIA groups at any time point after operation（P〉0.05）.The serum IL-6 level was significantly higher in PCSA or PCIA groups than that in PCEA groups at 1day after surgery（T3）.Conclusion： No significant differences were found between PCSA and PCIA groups in serum IL-2,IL-6 levels and WBC count,PCEA can reduce postoperative serum IL-6 levels much more than PCSA or PCIA groups.

关 键 词：皮下自控镇痛 食管癌 细胞因子 

分 类 号：R614[医药卫生—麻醉学]