文章摘要

硬膜外镇痛与静脉镇痛对卵巢肿瘤减灭术患者应激、T 淋巴细胞亚群及肿瘤因子的影响

作者: 1董 经纬, 1车 向明
1 首都医科大学附属北京妇产医院妇产科,北京 100006
通讯: 车 向明 Email: sdchexiangming@163.com
DOI: 10.3978/j.issn.2095-6959.2019.02.008

摘要

目的:观察硬膜外镇痛与静脉镇痛对卵巢肿瘤减灭术患者应激、T淋巴细胞亚群、肿瘤因子以及生存情况的影响。方法:选取2013年1月至2015年1月于首都医科大学附属北京妇产医院就诊的 84例卵巢癌患者,患者均行肿瘤细胞减灭术,按照随机数字法则分为2组,每组42例,其中硬膜外镇痛组采用硬膜外镇痛,静脉镇痛组采用静脉镇痛,记录2组患者手术时间、出血量以及住院时间,对比2组患者手术前30 min、手术后24 ,48和72 h应激指标皮质醇(CRH)、生长激素(growth hormone,GH)以及前列腺素E2(prostaglandin E2,PGE2),T淋巴细胞亚群CD3+,CD4+ 和CD8+以及CD4+/CD8+比值,肿瘤坏死因子-α(TNF-α)以及3年生存率差异。结果:2组患者的平均手术时间、术中出血量以及住院时间差异无统计学意义(P>0.05);手术前30 min,2组患者应激指标CRH,GH,PGE2以及TNF-α差异无统计学意义(P>0.05)。手术后24,48及72 h,2组患者的CRH,GH,PGE2和TNF-α先升高后降低(Ftime=42.471,14.162,78.918,10.354;P<0.05),其中硬膜外镇痛组变化幅度明显高于静脉镇痛组(Fgroup*time=39.415,13.997,70.244,9.168;P<0.05);手术前30 min,2组患者T淋巴细胞变化差异无统计学意义(P>0.05)。手术后24,48以及72 h,2组患者的CD3+,CD4+以及CD4+/CD8+先降低后升高,而CD8+先升高后降低(Ftime=12.581,17.162, 18.872,14.946;P<0.05),硬膜外镇痛组患者CD3+,CD4+以及CD4+/CD8+明显高于静脉镇痛组,而CD8+明显低于静脉镇痛组(Fgroup=11.037,14.536,15.718,10.718;P<0.05)。其中硬膜外镇痛组变化幅度明显高于静脉镇痛组(Fgroup*time=9.425,15.815,16.714,12.019;P<0.05)。所有患者均完成随访,硬膜外镇痛组3年生存率为35.70%(15/42),静脉镇痛组3年生存率为33.30%(14/42),组间比较差异无统计学意义(P=0.680)。结论:硬膜外镇痛能够降低患者的应激反应,并起到保护机体免疫功能的作用,但对患者的生存率影响不明显。
关键词: 硬膜外镇痛;静脉镇痛;肿瘤减灭术;应激;T淋巴细胞

Effects of epidural analgesia and intravenous analgesia on stress, T-lymphocyte subsets and tumor factors in patients undergoing ovarian tumor reduction

Authors: 1DONG Jingwei, 1CHE Xiangming
1 Department of Obstetrics and Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China

CorrespondingAuthor:CHE Xiangming Email: sdchexiangming@163.com

Abstract

Objective: To observe the effects of epidural analgesia and intravenous analgesia on stress, T-lymphocyte subsets, tumor factors and survival of ovarian tumor patients undergoing ovarian tumor reduction. Methods: From January 2013 to January 2015, 84 patients with ovarian cancer were selected as the research objects, all patients were performed tumor cells to destroy the loss, in accordance with the laws of random numbers, they were divided into two groups, each group of 42 cases. Epidural analgesia was used in epidural analgesia group. Intravenous analgesia was used in the intravenous analgesia group. Two groups of patients with operation time, blood loss and length of hospital stay were recorded. Two groups of patients before surgery 30 min, 24 h, 48 h and 72 h after surgery stress index cortisol (CRH), growth hormone (GH) and prostaglandin E2 (PGE2), T lymphocyte subsets CD3+, CD4+ and CD8+ and CD4+/CD8+ ratios, tumor necrosis factor-α (TNF-α), and 3-year survival rate differences were compared. Results: The operative time, intraoperative blood loss and hospitalization time of the two groups were not statistically significant (P>0.05). CRH, GH, PGE2 and TNF-α were not statistically significant in the two groups 30min before surgery (P>0.05). CRH, GH, PGE2 and TNF-α decreased at 24, 48 and 72 h after the surgery (Ftime=42.471, 14.162, 78.918, 10.354; P<0.05), and the change range of epidural analgesia was significantly higher than that of intravenous analgesia (Fgroup*time=39.415, 13.997, 70.244, 9.168; P<0.05). T lymphocyte changes in the two groups were not statistically significant 30 min before the surgery (P>0.05). CD3+, CD4+ and CD4+/CD8+ decreased first and then increased, while CD8+ decreased first and then decreased (Ftime=12.581, 17.162, 18.872, 14.946, P<0.05). CD3+, CD4+ and CD4+/CD8+ were significantly higher in the epidural analgesia group than in the intravenous analgesia group, while CD8+ was significantly lower than in the intravenous analgesia group (Fgroup=11.037, 14.536, 15.718, 10.718; P<0.05). The change range of the epidural analgesia group was significantly higher than that of the intravenous analgesia group (Fgroup*time=9.425, 15.815, 16.714, 12.019; P<0.05). All patients were followed up, and the three-year survival rate was 35.70% (15/42) in the epidural analgesia group and 33.30% (14/42) in the intravenous analgesia group, with no statistical significance (P=0.680). Conclusion: Epidural analgesia can reduce the stress response of patients and protect the body’s immune function, but the effect on the survival rate of patients is not obvious.
Keywords: epidural analgesia; intravenous analgesia; tumor reduction; stress; T lymphocyte