舒芬硬膜外术后镇痛对免疫系统保护作用的观察

Clinical observation of the effects of sunfentanil epidural pain therapy on immune functions

关键词:  病人自控硬膜外镇痛；病人自控静脉镇痛  免疫功能

Key words:  patient-controlled epidural analgesia  patient-controlled IV analgesia  immune functions

摘要:

[目的] 观察舒芬硬膜外术后镇痛对免疫系统的影响。 [方法] 采取双盲、对照、随机法，将40个入选病人分为两组,即病人自控静脉镇痛组（PCIA；吗啡3 mg/15 min）和病人自控硬膜外镇痛组（PCEA；0.125% 罗哌卡因+舒芬太尼1 μg/mL，基础量12 mL/h，追加量5 mL/15 min）。测定反映免疫功能特征的循环细胞素、C-反应蛋白（CRP）、皮质醇以及免疫细胞表面受体表达等。 [结果] PCEA组与PCIA组相比，循环细胞因子和应激反应指标（如CRP和皮质醇）等均无变化。单核细胞数和人白细胞抗原-DR、CD86、CD71表达差异也无显著性意义。术后B淋巴细胞和T-辅助细胞在PCEA组有明显减少。PCEA组与PCIA组相比，自然杀伤细胞也明显减少。 [结论] PCEA明显参与特异性免疫功能, 并且能减弱与抗感染有关淋巴细胞的抑制作用,即对免疫系统有保护作用。

Abstract:

[Objective] To observe the effects of sunfentanil epidural pain therapy on immune functions. [Methods] In a randomized, controlled, double-blinded prospective trail, 40 patients received either conventional patient-controlled IV analgesia （PCIA; morphine 3 mg/15 min） or patient-controlled epidural analgesia （PCEA; 0.125% ropivacaine plus sufentanil 1 μg/mL at a base rate of 12 mL/h and bolus application of 5 mL/15 min）. Circulating cytokines, C-reactive protein （CRP）, cortisol, and cell-surface receptor expression of immune cells were measured perioperatively to characterize immunological functions. [Results] PCEA, compared with PCIA, had no influence on altered levels of circulating cytokines or indicators of the stress response （CRP and cortisol）. Also, no significant difference was found in monocyte numbers or their human leukocyte antigen-DR, CD86, or CD71 expression. In contrast, the postoperative decrease in B lymphocytes and T-helper cells was significant in the PCEA group. Natural killer cells decreased significantly in patients receiving PCEA compared with PCIA. [Conclusions] Epidural analgesia influences the specific rather than the innate immune system and potentially blunts the postsurgical lymphocyte depression, which is relevant for infectious resistance.