不同镇痛方式对新辅助化疗后卵巢癌手术患者免疫功能的影响

目的 探讨硬膜外镇痛与静脉镇痛对新辅助化疗后卵巢癌手术患者的免疫功能影响.方法 40例已行新辅助化疗的卵巢癌手术治疗患者,年龄31 -62岁,硬膜外镇痛组（E组）及静脉镇痛组（Ⅰ组）,每组20例.均在静脉全麻下完成手术.E组于关腹前0.5h硬外注射吗啡2 mg,接硬膜外镇痛泵,泵内配方为罗哌卡因复合吗啡,镇痛48 h.Ⅰ组于关腹前0.5h静脉注射舒芬太尼0.1 μg/kg,接镇痛泵,泵内配方为舒芬太尼复合氟比洛芬酯,镇痛48 h.于术前30min（T0）、术毕（T1）、术后12 h（T2）、术后24 h（T3）和术后48 h（T4）时采患者右上肢静脉血样测定T淋巴亚群CD3＋、CD4＋、CD8＋和自然杀伤细胞（NK细胞）水平,同时计算CD4＋/CD8＋比值.于T2-4时点记录患者疼痛视觉模拟评分（VAS）及镇痛相关不良反应.结果 2组VAS评分及不良反应比较差异无统计学意义.与To比较,2组T1及T2时点及Ⅰ组T3-4时点CD3＋、CD4＋、CD4＋/CD8＋、NK细胞水平下调,CD8＋水平升高.与E组比较,Ⅰ组T24时点CD3＋、CD4＋、CD4 ＋/CD8＋、NK细胞水平下调;CD8＋水平升高.结论 对于新辅助化疗后的卵巢癌患者,术后采用硬膜外镇痛比静脉镇痛更有助于保存免疫功能.

Effects of different analgesia protocols on immune function in patients undergoing surgery for ovarian neoplasms after neoadjuvant chemotherapy

Objective To investigate the effects of different analgesia protocols on immune function in patients undergoing surgery for ovarian neoplasms after neoadjuvant chemotherapy.Methods Forty ovarian neoplasms patients ageing from 31 to 62 years undergoing neoadjuvant chemotherapy were randomly divided into 2groups：epidural analgesia group （group E,n =20） and intravenous analgesia group （group Ⅰ,n =20）.All patients underwent surgery under total intravenous general anesthesia.Patients in group E were given 2 mg morphine in epidural space at half an hour before abdomen was closed,then epidural analgesia pump was installed,with ropivacaine composite morphine in the pump.Analgesia time was 48 h.Patients in group Ⅰ were given sufentanil 0.1 μg/kg intravenously at half an hour before abdomen was closed,then analgesia pump was installed,with sufentanil compound flurbiprofen ester in the pump.Analgesia time was 48 h.The cervical venous blood samples were obtained from the patients at 30 min before surgery（T0）,immediately（T1）,12 h（T2）,24 h（T3） and 48 h （T4） after the end of operation for determination of the expression of CD3 ＋,CD4 ＋,CD8 ＋ on T cells and natural killer cell.Visual analogue scales （VAS）and adverse reaction at T2-4 were recorded.Results No statistical difference was found between group E and group Ⅰ in VAS and adverse reaction.Compared with T0,CD3 ＋,CD4 ＋ T-lymphocytes,CD4 ＋/CD8 ＋,and NK cell decreased.Compared with group E,CD8 ＋ increased at T1-2in both groups and at T3-4 in group Ⅰ.CD3 ＋,CD4＋ T-lymphocytes,CD4＋/CD8 ＋ and NK cell decreased while CD8 ＋ increased at T2-4 in group Ⅰ.Conclusion Epidural analgesia may be better to promote the immunologic function of ovarian neoplasms patients undergoing surgery after neoadjuvant chemotherapy.