两种镇痛方式对胃癌术后患者免疫功能的影响

目的 比较持续硬膜外与持续静脉镇痛对胃癌患者术后镇痛效果及免疫功能的影响。方法 20例择期行胃癌手术的患者，随机分为硬膜外镇痛组(E组)及静脉镇痛组(Ⅰ组)，每组10例，分别于麻醉诱导后、术毕1h、术后第1、3日晨抽血测定白细胞介素6(IL—6)、T细胞亚群CD4^ 和CD8^ ，计算CD4^ ／CD8^ 比值，并观察两组术后镇痛及镇静情况。结果 两种镇痛方法镇痛效果无明显差异，Ⅰ组的镇静程度较E组深，两组术后IL-6均上升，T细胞亚群、CD4^ ／CD8^ 均明显下降，但E组恢复较Ⅰ组早。结论 两种镇痛方式均能获得良好的镇痛效果，与静脉镇痛相比，硬膜外镇痛在一定程度上减轻了免疫抑制，利于患者免疫功能的早期恢复。

Influence of intraveneous or epidural analgesia on immunoreaction in patients with gastric carcinoma postoperatively

Objective To evaluate the influence of two analgesic techniques on the immune response in patients with gastric carcinoma postoperatively Methods Sixteen patients undergoing elective gastrectomy for cancer were assigned to epidural analgesia group (group E) and intravenous analgesia group (group I).Interleukin 6 (IL 6),T lymphocyte subsets(CD4 +,CD8 +) as parameters of the acute phase responses were measured Blood samples were taken after induction of anesthesia at 1 h after operation,on the 1st and 3rd postoperative day VAS and RSS were used to evaluate the analgesic and sedative effects Results Pain relief was similar in both groups,but the RSS was higher in group I than that in group E In two groups, CD4 +,CD8 +, CD4 +/CD8 + decreased significantly and IL 6 increased significantly at 1 h postoperatively( P< 0 05) In group E, on the 1st postoperative day the parameters recovered to the status of after induction( P> 0 05),but in group I, at 1 h ,on the 1st and 3rd postoperative day, the parameters were significantly different from those after induction( P< 0 05) Conclusions In patients after gastrectomy,epidural and intravenous analgesia are both effective The epiudural analgesia could decrease to ceryain degree the immune responses compared with intravenous analgesia