氯诺昔康超前镇痛对胃癌患者围术期Th1/Th2平衡的影响

目的 观察氯诺昔康超前镇痛对胃癌患者围术期Th细胞漂移的影响.方法 30例全麻下行胃癌根治术的患者随机均分为两组.Ⅰ组患者术前给予氯诺昔康8mg.手术后PCA泵以氯诺昔康和吗啡镇痛;Ⅱ组仪在术后经PCA泵给予吗啡镇痛.分别于术前(T_0)、术毕(T_1)、术后24 h(T_2)、72 h(T_3)抽取外周血.测定血浆皮质醇(Cor)、干扰素-γ(IFN-γ)、白细胞介素-4(IL-4)浓度.结果 与T_0,时比较,Ⅱ组T_1、T_2时Cor升高.I组Cor仅在T_1时升高(P<0.05).与Ⅱ组比较,I组T_1、T_2时Cor明显降低(P<0.05).Ⅰ组T_2时IL-4低于T_0(P<0.05).与Ⅱ组比较.Ⅰ组T_3时IL-4明显降低(P<0.05).与T_0时比较,两组T_1～T_3时IFN-γ明显上升(P<0.05).Ⅰ组T_1、T_2时IFN-γ明显高于Ⅱ组(P<0.05).与T_0时比较,两组T_1～T_3.时IFN-γ/IL-4均升高(P<0.05);Ⅰ组T_2时IFN-γ/IL-4明显高于Ⅱ组(P<0.05).结论 氯诺昔康超前镇痛能减轻胃癌患者手术后Th1/Th2半衡的漂移程度.改善机体外科创伤后免疫受抑状态.

Influence of preemptive analgesia with Iornoxicam on balance of Th1/Th2 during radical gastrectomy

Objective To observe the effect of preemptive analgesia with lornoxicam on balance of Th1/Th2 during radical gastrectomy. Methods Thirty patients undergoing selective radical gastrectomy were randomly divided into 2 groups with 15 cases each. Lornoxicam 8 mg was used.before surgery,and PCA with lornoxieam and morphine was used for postoperative analgesia in group Ⅰ.PCA with morphine was used for postoperative analgesia in group Ⅱ. Plasma cortisol, interferon-γ(IFN-γ) and interleukin-4 (IL-4) were measured before induction of anesthesia(T_0 ), at the end ofoperation(T_1 ),at 24 h(T_1 ) and 72 h(T_3 ) after operation. Results Compared to that at T_0 ,Cor washigher at T_1 and T_2 in group Ⅱ and at T_2in group I(P<0. 05). (Cor levels at T_1 and T_2were lower ingroup Ⅰ than those in group Ⅱ(P<0. 05). IL-4 of group Ⅰ was lower at T_2 than that at T_0 (P<0.05). IL_4 at T_3 was lower in group Ⅰ than that in group Ⅱ (P < 0.05). IFN-γ of group Ⅰ washigher at T_1 than that at T_0 (P<0. 05), which was higher at T_2 than that of group Ⅱ(P＜0. 05). Theratio of IFN-γ/IL-4 in both groups was significantly higher at T_1-T_3 than those at T_0, which at T_2 washigher in group Ⅰ than that in group Ⅱ (P<0. 05). Conclusion Preemptive analgesia with lornoxicamcan alleviate the excurtion degree of Th1/Th2 and improve inmmnological suppression after radicalgastrectomy.