硬膜外自控镇痛对肺癌患者术后机体整体功能状态的影响  

Effect of patient-controlled epidural analgesia on the postoperative overall functional status of patients with lung cancer

作　　者：冉婷 张微 林小路 邹香 

机构地区：[1]重庆涪陵中心医院麻醉手术科,重庆408000

出　　处：《海南医学》2018年第5期650-653,共4页Hainan Medical Journal

基　　金：重庆市科技计划项目(编号:Y2015032)

摘　　要：目的探讨硬膜外自控镇痛(PCEA)对肺癌患者术后机体整体功能状态的影响。方法选取2016年1月至2017年6月在重庆涪陵中心医院行肺癌手术治疗的60例患者为研究对象,采用随机数表法分为对照组与观察组,每组30例,术后对照组给予静脉自控镇痛(PCIA),观察组给予PCEA,镇痛药物配方相同,观察患者术前及术后48 h时炎症及免疫指标和肺功能的变化,并比较术后24 h与48 h时静息及活动时的镇痛效果。结果两组患者高敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-8(IL-8)水平组内比较术后48 h时较术前升高,术后48 h时以上指标对照组明显高于观察组,差异均有统计学意义(P<0.05);两组患者CD3+、CD4+水平组内比较术后48 h时较术前下降,术后48 h时以上指标对照组明显低于观察组,差异均有统计学意义(P<0.05);两组患者用力肺活量(FVC)、第一秒用力呼气量(FEV1)、吸气时动脉氧饱和度(Sp O2)水平组内比较术后48 h时较术前下降,术后48 h时以上指标对照组明显低于观察组,差异均有统计学意义(P<0.05);两组患者术后24 h静息及活动时VAS评分比较差异均无统计学意义(P>0.05),对照组患者术后48 h静息及活动时VAS评分分别为(2.97±0.67)分和(5.30±0.27)分,明显高于观察组的(2.48±0.53)分和(4.94±0.22)分,差异均有统计学意义(P<0.05)。结论肺癌手术患者术后PCEA镇痛效果优于PCIA,其有助于减轻患者炎症应激反应,对免疫及肺功能影响较小。Objective To investigate the effect of patient-controlled epidural analgesia （PCEA） on the postoper-ative overall functional status of patients with lung cancer. Methods Sixty patients with lung cancer who underwentsurgical treatment in Fuling Central Hospital of Chongqing form January 2016 to June 2017 were selected as the re-search objects. They were randomly divided into the control group and observation group accroding to the random num-ber table, with 30 patients in each group. After operation, the control group received patient-controlled intravenous anal-gesia （PCIA） treatment, and the observation group received PCEA treatment. The analgesic drug formula was the sameas that in the two groups. Changes of inflammatory and immune indexes, and pulmonary function in patients before and48 h after operation were observed. The analgesic effects of rest and activity at 24 h and 48 h after operation were com-pared. Results The levels of high sensitive C-reaction protein （hs-CRP）, tumor necrosis factor alpha （TNF-α）, interleu-kelin-6 （IL-6）, and interleukelin-8 （IL-8） of 48 h after surgery were significantly higher than those before surgery inthe two groups, and the above indicators of 48 h after surgery in the control group were significantly higher than those inthe observation group （P〈0.05）. The levels of CD3＋ and CD4＋ of 48 h after surgery were significantly lower than thosebefore surgery in the two groups, and the above indicators of 48 h after surgery in the control group were significantlylower than those in the observation group （P〈0.05）. The levels of forced vital capacity （FVC）, forced expiratory volumein one second （FEV1） and SpO2 of 48 h after surgery were lower than that before surgery in the two groups, and theabove indicators of 48 h after surgery in the control group were significantly lower than those in the observation group（P〈0.05）. There was no significant difference in VAS scores between the two groups at 24 hours after operation （P〉0.05�

关 键 词：硬膜外自控镇痛 肺癌 应激功能 免疫功能 肺功能 

分 类 号：R734.2[医药卫生—肿瘤]