硬膜外镇痛对肿瘤细胞减灭术治疗的卵巢癌患者应激、免疫和生存的影响  

The influence of epidural analgesia on stress, immune and survival in patients with ovarian cancer un- dergoing cytoreductive surgery

作　　者：马婷婷[1] 陆方晓[2] 王冬冬[1] 周程[1] 

机构地区：[1]浙江省立同德医院麻醉科,杭州310012 [2]浙江省肿瘤医院放射科,杭州310022

出　　处：《中华内分泌外科杂志》2017年第2期135-139,共5页Chinese Journal of Endocrine Surgery

摘　　要：目的探讨硬膜外镇痛对肿瘤细胞减灭术治疗的卵巢癌患者应激、免疫和生存的影响。方法将72例行肿瘤细胞减灭术治疗的卵巢癌患者按照随机数字表法分为A组和B组，A组采用硬膜外镇痛，B组采用静脉镇痛，对比观察2组术前30min（T1）、术毕（T2）、术后12 h（T3）、术后1 d（T4）和术后3 d（T5）时间点应激指标、血浆皮质醇和免疫指标、CD3＋、CD4＋、CD8＋和CD4＋/CD8＋差异，对患者进行随访，对比2组总生存期和无瘤生存期差异。结果A组血浆皮质醇水平低于B组（F分组=27.784，P=0.000），2组血浆皮质醇水平随着时间的延迟先升高后降低（F时间=109.268，P=0.000），A组升高后降低的幅度大于B组（F交互=22.092，P=0.000）；A组CD3＋、CD4＋、CD4＋/CD8＋水平高于B组，CD8＋水平低于B组（F分组=5.893、6.110、7.283、5.593，P〈0.05）；2组CD3＋、CD4＋、CD4＋/CD8＋水平随着时间的延迟先降低后升高，CD8＋先升高后降低（F时间=12.220、14.430、15.592、11.102，P〈0.05），A组CD3＋、CD4＋、CD4＋/CD8＋降低后升高的幅度，CD8＋升高后降低的幅度大于B组（F交互=8.251、9.792、8.092、7.103，P〈0.05）；A组3年总生存率为44.44%，3年无瘤生存率为22.22%，B组为38.89%和16.67%，2组比较差异均无统计学意义（P〉0.05）。结论硬膜外镇痛可能可降低肿瘤细胞减灭术治疗的卵巢癌患者应激反应，保护免疫功能，但对生存期的影响并不明显。ObjectiveTo explore the influence of epidural analgesia on stress, immune and survival in patients with ovarian cancer undergoing cytoreductive surgery.Methods72 cases with ovarian cancer undergoing cytoreductive surgery were divided into group A and group B according to random number table method. Patients in group A were treated with epidural analgesia, while patients in group B were treated with intravenous analgesia. The stress index, the plasma cortisol and immune indexes, CD3＋, CD4＋, CD8＋ and CD4＋/CD8＋ at 30 mins before surgery （T1） , right after surgery （T2） , 12 h after surgery （T3） , 1 d after surgery （T4） and 3 d after surgery （T5） between the two groups were observed. The overall survival and free survival in the two groups were compared.ResultsThe plasma cortisol levels was lower in group A than in group B （Fgroup=27.784, P=0.000） . The plasma cortisol levels in the two groups increased first and then decreased （Ftime=109.268, P=0.000） , and the decrease rate in group A was higher than that in group B （Finteraction=22.092, P=0.000） . The levels of CD3＋, CD4＋ and CD4＋/CD8＋ were higher in group A than in group B, while the level of CD8＋ was lower in group A than in group B （Fgroup=5.893, 6.110, 7.283, 5.593, P〈0.05） . The levels of CD3＋, CD4＋ and CD4＋/CD8＋ in the two groups reduced first and then increased while the level of CD8＋ increased first and then reduced （Ftime=12.220, 14.430, 15.592, 11.102, P〈0.05） . CD3＋, CD4＋ and CD4＋/CD8＋ in group A increased more while CD8＋ reduced more than those in group B （Finteraction=8.251, 9.792, 8.092, 7.103, P〈0.05） . The overall survival rate and free survival rate of 3 years in group A and group B was 44.44%, 22.22% vs 38.89%, 16.67%, respectively. The difference had no statistical significance between the two groups （P〉0.05） .ConclusionEpidural analgesia may reduce the stress response in patients with ovarian cancer undergoing cytoreductive surgery, and protect the im

关 键 词：硬膜外镇痛 肿瘤细胞减灭术 卵巢癌 应激 免疫 生存期 

分 类 号：R737.31[医药卫生—肿瘤]