帕瑞昔布钠超前镇痛对食管癌手术患者外周T淋巴细胞亚群分化的影响

李灿; 郑蓉

帕瑞昔布钠超前镇痛对食管癌手术患者外周T淋巴细胞亚群分化的影响

李灿,
郑蓉

1.
华中科技大学同济医学院附属荆州医院麻醉科

作者简介: 李灿(1976－)，男，主治医师．

基金项目:

Effects of preemptive analgesia of parecoxib sodium on T lymphocyte subsets in patients with esophageal carcinoma surgery

LI Can,
ZHENG rong

1.
Department of Anesthesiology, Affiliated Jingzhou Hospital of Tongji Medical College, Huazhong University of Science & Technology, Jingzhou Hubei 434020, China

摘要: 目的：探讨帕瑞昔布钠超前镇痛对食管癌患者围手术期细胞免疫功能的影响。方法：50例择期全麻下行食管癌根治术患者随机分为2组，P组患者麻醉诱导前30min静脉注射帕瑞昔布钠40mg(5ml)；C组麻醉诱导前30min静脉注射0.9%氯化钠注射液5ml，2组患者术后均予以患者自控硬膜外镇痛。于麻醉前、手术中2h及术后24h、48h等4个时间点用流式细胞仪检测T淋巴细胞亚群(CD4+、CD8+)及辅助性T淋巴细胞(Th细胞)水平。结果：2组患者麻醉前CD4+、CD8+T淋巴细胞、Th1、Th2细胞水平和Th1/Th2比值差异均无统计学意义(P0.05)；2组患者CD4+、CD4+/CD8+水平于术中2h、术毕24、48h均较麻醉前降低(P0.01)；与C组比较，P组CD4+在术毕24h和48h、CD4+/CD8+在术中2h、术毕24、48h均高于C组(P0.05～P0.01)；与麻醉前比较，2组术毕24、48hTh1与Th1/Th2比值均较麻醉前下降(P0.05～P0.01)，而Th2则均升高(P0.05和P0.01)；P组Th1/Th2比值在术毕24、48h均明显高于C组(P0.05和P0.01)。结论：帕瑞昔布钠超前镇痛可以通过降低CD4+T淋巴细胞数量下降幅度与抑制Th1/Th2平衡趋向于Th2免疫反应的方式，减轻肿瘤患者免疫抑制。
- 镇痛 /
- 帕瑞昔布钠 /
- T淋巴细胞亚群 /
- Th分化
Abstract: Objective:To investigate the effects of preemptive analgesia of parecoxib sodium on cellular immune function in perioperative period of patients with esophageal carcinoma.Methods:Fifty patients scheduled for esophageal carcinoma surgery were randomly divided into P and C group.Group P and C were injected with 5 ml of parecoxib sodium(40 mg)and normal saline at 30 minutes before anesthesia induction respectively.Two groups were treated with patient controlled epidural analgesia after operation.The levels of T-lymphocyte subsets(CD4+and CD8+)and T helper lymphocytes differetiation were measured by flow cytometry before anesthesia induction,at 2 hours after the start of operation and 24 and 48 hours after operation.Results:The differences of the levels of CD4+＆ CD8+,Th1 ＆ Th2 and ratio of Th1 and Th2 in two groups were not statistical significance before anesthesia(P0.05).Compared with before anesthesia,the levels of CD4+and CD4+/CD8+in two groups decreased at 2 hours after the start of operation and 24 and 48 hours after operation(P0.01).Compared with group C,the levels of CD4+at 24 and 48 hours after operation and CD4+/CD8+at 2 hours after the start of operation and 24 and 48 hours after operation in group P were higher(P0.05 to P0.01).Compared with before anesthesia,the levels of Th1 and ratio of Th1 and Th2 in two groups decreased at 24 and 48 hours after operation(P0.05 to P0.01),while the Th2 level significantly increased(P0.05 and P0.01).The ratio of Th1 and Th2 in group P was significantly higher than that in group C at 24 and 48 hours after operation(P0.05 and P0.01).Conclusions:Preemptive analgesia of parecoxib sodium may alleviate immunosuppression in tumor patients by the way of lowering the decreasing index of CD4+T lymphocyte,inhibiting the tendency of Th1/Th2 balance and activating Th2 immune response.
- analgesia /
- parecoxib /
- T lymphocyte subset /
- T helper lymphocyte differentiation

[1]	Vuori A,Salo M,Viljanto J,et al.Effects of post operative pain treatment using non-steroidal anti-inflammatory analgesics,opioids or epidural blockade on systemic and local immune responses in children[J].Acta Anaesthesiol Scand,2004,48(6):738-749.
[2] Ogawa K,Hirai M,Katsube T,et al.Suppression of celluar immunity by Surgical stress[J].Surgery,2000,127(3):329-336.
[3] Lennard TW,Shenton BK,Borzotta A,et al.The influence of surgical operations on components of the human immune system[J].Br J Surg,1985,72(10):771-776.
[4] Leaver HA,Craig Sr,Yap PL,et al.Lymphocyte responses following open and minimally invasive thoracic surgery[J].Eur J Clin Invest,2000,30(3):230-238.
[5] Weissman C.The metabolic response to stress:an overview and update[J].Anesthesiology,1990,73(2):308-327.
[6] Yokoyama M,Itano Y,Katayama H,et al.The effects of continuous epidural anesthesia and analgesia on stress response and immune function in patients undergoing radical esophagectomy[J].Anesth Analg,2005,101(5):1521-1527
[7] 周光炎.免疫学原理[M].上海:上海科学技术文献出版社,2000:32.
[8] 徐德生,王国年,王玉.不同镇痛药物经静脉超前镇痛效应的观察[J].临床麻醉学杂志,2005,21(3):168-170.
[9] Kissin I.Preemptive analgesia[J].Anesthe Analg,2005,100(3):774-780.
[10] reuben SS,Ekman EF,raghunathan K,et al.The effect of cyclooxygenase-2 inhibition on acute and chronic site pain after spinal-fusion surgery[J].reg Anesth pain Med,2006,31(1):6-13.
[11] Pinto rA,Arredondo SM,Bono Mr.T helper 1/T helper 2 cytokine imbalance in respiratory syncytial virus infection is associated with increased endogenous plasma cortisol[J].Pediatrics,2006,117(5):e878-e886.
[12] roy S,Balasubramanian S,Sumandeep S,et al.Morphine directs T cells toward T(H2)differentiation[J].Surgery,2001,130(2):304-309.

[1]	沈勤 , 肖建军 , 吴宣 . 帕瑞昔布钠预防性镇痛对全麻苏醒期躁动的影响. 蚌埠医学院学报, 2014, 39(10): 1380-1382.
[2]	沈勤 , 肖建军 , 吴宣 . 帕瑞昔布钠超前镇痛对腰椎手术后患者静脉自控镇痛疗效的影响. 蚌埠医学院学报, 2013, 37(1): 40-42.
[3]	黄国喜 , 刘训碧 , 王钢胜 . 帕瑞昔布钠预防瑞芬太尼麻醉术后痛觉过敏的临床观察. 蚌埠医学院学报, 2017, 42(7): 868-870,874. doi: 10.13898/j.cnki.issn.1000-2200.2017.07.009
[4]	陶静 , 陈菲菲 , 周家龙 , 王宏 , 梁启胜 . 预注帕瑞昔布钠防治小儿七氟烷麻醉苏醒期躁动的临床研究. 蚌埠医学院学报, 2016, 41(11): 1431-1435. doi: 10.13898/j.cnki.issn.1000-2200.2016.11.008
[5]	谢言虎 , 柴小青 , 崔中露 , 高燕春 , 许敏 . 帕瑞昔布钠对瑞芬太尼麻醉下肢骨折患者手术后急性痛的影响. 蚌埠医学院学报, 2014, 39(11): 1524-1527.
[6]	郑立东 , 杨松保 . 地塞米松对吗啡、布比卡因、氟哌利多术后连续硬膜外镇痛的影响. 蚌埠医学院学报, 2004, 29(5): 446-447.
[7]	汤海珍 , 韩雪敏 , 赵伟 , 门秀婷 , 赵恒 , 钟传飞 . 盐酸纳布啡复合枸橼酸舒芬太尼在剖宫产术后镇痛中的应用效果. 蚌埠医学院学报, 2019, 44(5): 627-631. doi: 10.13898/j.cnki.issn.1000-2200.2019.05.018
[8]	金平 . 不同剂量氟比洛芬酯注射液对分化型甲状腺癌术后镇痛效果和炎症因子水平的影响. 蚌埠医学院学报, 2017, 42(6): 761-763. doi: 10.13898/j.cnki.issn.1000-2200.2017.06.020
[9]	苗雨露 , 张明霞 . 重型颅脑损伤T淋巴细胞亚群的变化. 蚌埠医学院学报, 2015, 40(5): 624-626. doi: 10.13898/j.cnki.issn.1000-2200.2015.05.021
[10]	郭佳丽 , 茆康卫 , 杨自金 , 王娟 , 李红梅 , 陈刚 . 培土生金穴位敷贴对CVA患儿免疫球蛋白及T淋巴细胞亚群的影响. 蚌埠医学院学报, 2019, 44(8): 1084-1086. doi: 10.13898/j.cnki.issn.1000-2200.2019.08.030
[11]	王文雅 , 张秀敏 , 杜会双 , 徐敬梅 . 阿奇霉素对支原体肺炎患儿血清IgA、IgG、IgM水平及T淋巴细胞亚群的影响. 蚌埠医学院学报, 2016, 41(2): 175-177. doi: 10.13898/j.cnki.issn.1000-2200.2016.02.012
[12]	王勇 . 晚期恶性肿瘤患者化疗前后外周血T淋巴细胞亚群监测及临床意义. 蚌埠医学院学报, 2016, 41(11): 1452-1454. doi: 10.13898/j.cnki.issn.1000-2200.2016.11.014
[13]	梁友宝 , 梁华 , 李柏青 . 白介素-9产生细胞在不同淋巴细胞亚群中的比例. 蚌埠医学院学报, 2011, 36(5): 437-440.
[14]	彭卫东 , 盛福庭 , 李敏 . 地佐辛抑制瑞芬太尼致术后痛觉过敏临床观察. 蚌埠医学院学报, 2012, 36(10): 1215-1217.
[15]	王娟 , 王昌合 , 曲珣 . 硬膜外麻醉在分娩镇痛中的应用. 蚌埠医学院学报, 2014, 39(9): 1226-1228.
[16]	刘梅 . 重度妊娠高血压疾病剖宫产术后硬膜外镇痛对产妇血压、心率的影响. 蚌埠医学院学报, 2006, 31(5): 551-552.
[17]	叶爱华 . 硬膜外阻滞与氧化亚氮用于分娩镇痛疗效分析. 蚌埠医学院学报, 2004, 29(6): 508-510.
[18]	钱刚 , 赵宏程 , 李南 , 张光明 . 不同剂量纳洛酮配合吗啡对老年患者术后静脉镇痛效能的影响. 蚌埠医学院学报, 2012, 36(3): 316-318.
[19]	高平 , 汤园园 , 张树波 , 周春旺 , 韩晓亮 , 高晓增 . 麻醉护士产程调试在分娩镇痛中的应用价值. 蚌埠医学院学报, 2017, 42(8): 1131-1133. doi: 10.13898/j.cnki.issn.1000-2200.2017.08.037
[20]	刘梦雅 , 张颖 , 江勇 , 徐晖 , 吕爱俊 , 王南海 . 针刺穴位联合硬膜外分娩镇痛对产后抑郁症的影响. 蚌埠医学院学报, 2022, 47(5): 603-607. doi: 10.13898/j.cnki.issn.1000-2200.2022.05.011

点击查看大图

计量

文章访问数: 3206
HTML全文浏览量: 281
PDF下载量: 194
被引次数: 0

姓名
邮箱
手机号码
标题
留言内容
验证码

留言板

帕瑞昔布钠超前镇痛对食管癌手术患者外周T淋巴细胞亚群分化的影响

作者简介: 李灿(1976－)，男，主治医师．

Effects of preemptive analgesia of parecoxib sodium on T lymphocyte subsets in patients with esophageal carcinoma surgery

计量

帕瑞昔布钠超前镇痛对食管癌手术患者外周T淋巴细胞亚群分化的影响

作者简介: 李灿(1976－)，男，主治医师．

English Abstract

Effects of preemptive analgesia of parecoxib sodium on T lymphocyte subsets in patients with esophageal carcinoma surgery

全文HTML

目录

留言板

帕瑞昔布钠超前镇痛对食管癌手术患者外周T淋巴细胞亚群分化的影响

作者简介: 李灿(1976－)，男，主治医师．

Effects of preemptive analgesia of parecoxib sodium on T lymphocyte subsets in patients with esophageal carcinoma surgery

计量

出版历程

帕瑞昔布钠超前镇痛对食管癌手术患者外周T淋巴细胞亚群分化的影响

作者简介: 李灿(1976－)，男，主治医师．

English Abstract

Effects of preemptive analgesia of parecoxib sodium on T lymphocyte subsets in patients with esophageal carcinoma surgery

全文HTML

目录