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目的探讨不同模式的镇痛方法对结肠癌根治术患者的免疫功能的影响。方法选择150例结肠癌根治患者,ASAⅠ~Ⅱ级,随机分为5组,每组30例,Ⅰ组:空白组,不做任何术后镇痛;Ⅱ组:PCIA;Ⅲ组:PCEA;Ⅳ组:术毕切口注射0.5%的罗哌卡因20 ml+PCIA;Ⅴ组:术毕切口注射0.5%的罗哌卡因20 ml+PCEA。分别在麻醉前(T1)、术后1 h(T2)、24 h(T3)、48 h(T4)、72 h(T5)、120 h(T6)、168 h(T7)抽取外周静脉血测量各组患者的T细胞(CD3+、CD4+、CD8+)、NK、IL-2、IL-6、TNF-α、C3、C4和CRP的含量并作统计学差异比较和术后VAS疼痛评分。结果与Ⅰ组相比,Ⅱ、Ⅲ、Ⅳ和Ⅴ组T2~T5疼痛明显减轻(P<0.05),其中Ⅴ组的镇痛效果最佳;Ⅱ、Ⅲ、Ⅳ和Ⅴ组在T2~T5的CD3+、CD4+、NK和IL-2含量均明显升高,CD8+、IL-6、TNF-α、C3、C4和CRP的含量明显下降(P<0.05),Ⅴ组的免疫参数在各时点更接近T1水平。结论术毕切口注射0.5%的罗哌卡因20 ml+PCEA方案是结肠癌根治术后最佳镇痛方法,最大程度减轻患者的疼痛和应激反应,有利于患者免疫功能的恢复。
Objective To investigate the effects of different modes of analgesia on immune function in patients with colon cancer undergoing radical operation. Methods 150 patients with colon cancer who underwent radical resection were divided into 5 groups (30 cases in each group), group Ⅰ: blank group without any postoperative analgesia; group Ⅱ: PCIA; group Ⅲ: PCEA; Ⅳ Group: 0.5% Ropivacaine 20 ml + PCIA was injected at the end of operation; Group V: 0.5% ropivacaine 20 ml + PCEA was injected at the end of operation. Peripheral venous blood samples were taken before anesthesia (T1), at 1 h (T2), 24 h (T3), 48 h (T4), 72 h (T5), 120 h (T6), 168 h The levels of T cells (CD3 +, CD4 +, CD8 +), NK, IL-2, IL-6, TNF-α, C3, C4 and CRP in each group were compared and statistically significant differences were compared. Results Compared with group Ⅰ, the pain of T2 ~ T5 in group Ⅱ, Ⅲ, Ⅳ and Ⅴ was relieved (P <0.05), and the analgesic effect in group V was the best. In group Ⅱ, Ⅲ, Ⅳ and Ⅴ, The levels of CD3 +, CD4 +, NK and IL-2 were significantly increased and the levels of CD8 +, IL-6, TNF-α, C3, C4 and CRP were significantly decreased (P <0.05) Close to T1 level. Conclusions The 0.5% ropivacaine 20 ml + PCEA injection at the end of operation is the best analgesic method after radical operation for colon cancer, which can reduce the pain and stress response to the patients to the greatest extent and is beneficial to the recovery of immune function.