自控硬膜外镇痛对食管癌术后肺部感染干预效果及IL-10和TNF-α水平影响  

Patient controlled epidural analgesia effect on postoperative pulmonary infection and levels of IL-10 and TNF-αin patients with esophageal cancer

作　　者：姚鹏 田界勇 李道航[1] 陶一勤[1] 邓伟明 YAO Peng;TIAN Jie-yong;LI Dao-hang;TAO Yi-qin;DENG Wei-ming(Chaohu Hospital Affiliated to Anhui Medical University,Hefei,Anhui 238000,China;不详)

机构地区：[1]安徽医科大学附属巢湖医院胸外科,安徽合肥238000 [2]中国科学技术大学附属第一医院胸外科,安徽合肥230001

出　　处：《中华医院感染学杂志》2021年第15期2318-2322,共5页Chinese Journal of Nosocomiology

摘　　要：目的分析自控硬膜外镇痛(PCEA)对食管癌术后肺部感染患者的干预效果及对白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平的影响。方法选取2019年2月-2020年2月医院收治的行食管癌手术治疗的患者159例,按照随机数字表法分为自控硬膜外镇痛(PCEA)组91例、PCIA组68例。所有患者均行胸段硬膜外阻滞复合静脉全麻干预,PCIA组行自控静脉镇痛干预,PCEA组患者行自控硬膜外镇痛模式干预。对比两组患者麻醉前0.5 h(T1)、切皮后1 h(T2)、术后4 h(T3)、术后24 h(T4)、术后48 h(T5)时间点机体应激指标皮质醇(Cor)、应激激素生长激素(GH)、催乳素(PRL)水平、T淋巴细胞亚群指标CD3^(+)、CD4^(+)、CD8^(+)水平及CD4^(+)/CD8^(+)比值及IL-10、TNF-α水平变化及术后不同时间点疼痛情况,统计肺部感染发生情况。结果与T1时间点相比,两组患者T2时间点GH、Cor、PRL、IL-10、TNF-α水平均升高,T3、T4、T5时间点GH、Cor、PRL、IL-10、TNF-α水平逐渐降低,且PCEA组GH、Cor、PRL、IL-10、TNF-α水平低于PCIA组(P<0.05)。与T1时间点相比,两组患者T2时间点CD3^(+)、CD4^(+)水平、CD4^(+)/CD8^(+)值均降低,T3、T4、T5时间点CD3^(+)、CD4^(+)水平、CD4^(+)/CD8^(+)值逐渐升高,且PCEA组CD3^(+)、CD4^(+)水平、CD4^(+)/CD8^(+)值高于PCIA组(P<0.05)。与PCIA组相比,PCEA组术后不同时间点VAS评分均降低(P<0.05)。PCEA组肺部感染发生率3.30%低于PCIA组14.71%(P<0.05)。结论与PCIA相比,PCEA用于食管癌手术患者,可明显减轻患者机体应激反应、免疫功能抑制状态及IL-10、TNF-α异常变化,降低术后肺部感染的发生。OBJECTIVE To analyze the effect of patient controlled epidural analgesia(PCEA)on postoperative pulmonary infection in patients with esophageal cancer and interleukin-10(IL-10)and tumor necrosis factor-α(TNF-α)levels.METHODS Total of 159 patients with esophageal cancer treated in our hospital from Feb 2019 to Feb 2020 were recruited and randomly divided into the control epidural analgesia(PCEA)group(91 cases)and PCIA group(68 cases).All patients received thoracic epidural block combined with intravenous anesthesia intervention.Besides,patients in the PCIA group received patient-controlled intravenous analgesia intervention,and those in the PCEA group received patient-controlled epidural analgesia mode intervention.Levels of cortisol(Cor),growth hormone(GH),prolactin(PRL),lymphocyte subsets,CD4^(+)/CD8^(+)ratio and IL-10,TNF-αlevels between the two groups were compared at the time point of 0.5 h(T1),1 h(T2),4 h(T3),24 h(T4)and 48 h(T5)after anesthesia.And the postoperative pain and the incidence of pulmonary infection at these time points were statistically analyzed.RESULTS Compared with T1,the levels of GH,Cor PRL,IL-10 and TNF-αat T2 time point between both groups increased,while the levels of GH,COR,PRL,IL-10 and TNF-αdecreased gradually at T3,T4 and T5.The levels of GH,COR,PRL,IL-10 and TNF-αin the PCEA group were significantly lower than those in the PCIA group(P<0.05).Levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)decreased at T2,while CD3^(+),CD4^(+)levels and CD4^(+)/CD8^(+)values gradually increased at T3,T4 and T5,and CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)levels in the PCEA group were significantly higher than those in the PCIA group(P<0.05).Compared with the PCIA group,the VAS scores in the PCEA group were significantly decreased at different time points after operation(P<0.05).The incidence of pulmonary infection in the PCEA group was 3.30%,which was significantly lower than that in the PCIA group(14.71%,P<0.05).CONCLUSION Compared with PCIA,the PCEA can be used in patients after esophageal cancer surger

关 键 词：自控硬膜外镇痛 食管癌术后肺部感染 白介素-10 肿瘤坏死因子-α 

分 类 号：R619.3[医药卫生—外科学]