CAJ | 학술논문

目的：探究不同麻醉和镇痛方法对开胸手术患者外周血免疫细胞表面抗原及受体表达的影响。方法：选取我院胸外科收治的 ASAⅠ‐Ⅱ级择期行开胸手术患者90例，其中 A 组30例，处以静脉复合麻醉，术后经静脉予以吗啡镇痛；B 组30例，为静脉复合麻醉，术后经静脉曲马多镇痛；C 组30例，予以静脉复合麻醉联合胸部硬膜外麻醉，术后经静脉曲马多镇痛。分别于麻醉前（T1）、术毕（T2）、术后12h（T3）、术后36h（T4）四个时间点抽取静脉血，测定外周血 T 淋巴细胞亚群（CD3、CD4、CD8）及淋巴细胞表面抗原（CD25）、单核细胞表面抗原（CD14）的变化。结果：①3组患者在 T2和 T3各项指标均较 T1时降低（P＜0．05）；但 C 组 T2和 T3降低水平较轻，与 A 、B 组相比较有差异（P＜0．05）；② T4时 A 组处于低水平，与 T1时比较无明显差异（P＞0．05）；T4时 B 组 CD3、CD4、CD4／CD8、CD14和 CD25明显高于 A 组（P＜0．05）；③ T4时 C 组 CD3、CD4、CD4／CD8、CD14和 CD25较 B 组明显升高（P＜0．05）。结论：经静脉曲马多镇痛抑制术后免疫细胞表面抗原和受体的表达较吗啡轻，提示曲马多更适合于术后的镇痛，对临床具有指导意义。
목적：탐구불동마취화진통방법대개흉수술환자외주혈면역세포표면항원급수체표체적영향。방법：선취아원흉외과수치적 ASAⅠ‐Ⅱ급택기행개흉수술환자90례，기중 A 조30례，처이정맥복합마취，술후경정맥여이마배진통；B 조30례，위정맥복합마취，술후경정맥곡마다진통；C 조30례，여이정맥복합마취연합흉부경막외마취，술후경정맥곡마다진통。분별우마취전（T1）、술필（T2）、술후12h（T3）、술후36h（T4）사개시간점추취정맥혈，측정외주혈 T 림파세포아군（CD3、CD4、CD8）급림파세포표면항원（CD25）、단핵세포표면항원（CD14）적변화。결과：①3조환자재 T2화 T3각항지표균교 T1시강저（P＜0．05）；단 C 조 T2화 T3강저수평교경，여 A 、B 조상비교유차이（P＜0．05）；② T4시 A 조처우저수평，여 T1시비교무명현차이（P＞0．05）；T4시 B 조 CD3、CD4、CD4／CD8、CD14화 CD25명현고우 A 조（P＜0．05）；③ T4시 C 조 CD3、CD4、CD4／CD8、CD14화 CD25교 B 조명현승고（P＜0．05）。결론：경정맥곡마다진통억제술후면역세포표면항원화수체적표체교마배경，제시곡마다경괄합우술후적진통，대림상구유지도의의。
Objective :To explore the different folio chest surgery in patients with peripheral blood anes‐thesia and analgesia effects of immune cell surface antigen and the receptor expression .Methods :Department of tho‐racic surgery treated ASA Ⅰ ‐ level Ⅱ elective open chest surgery patient 90 cases ,A group of 30 cases ,with com‐pound vein anesthesia ,postoperative intravenous give morphine analgesia ;Group B ,30 cases of compound vein an‐esthesia ,postoperative intravenous tramadol analgesia ;C group of 30 cases ,compound vein anesthesia combined thoracic epidural anesthesia and postoperative intravenous tramadol analgesia .Respectively before anesthesia (T1 ) , bi (T2 ) ,12 hours after surgery (T3 ) ,36 hours after surgery (T4 ) four time points extraction of venous blood ,de‐termination of peripheral blood T lymphocyte subsets (CD3 ,CD4 ,CD8 ) and lymphocyte surface antigens (CD25 ) , the change of mononuclear cell surface antigen (CD14 ) .Results : ① Three groups of patients in various indexes de‐crease when the T1 T2 and T3 ;But to A lesser T2 and T3 group C lower levels ,compared with A ,B group have difference ;② When the T4 at A lower level ,group A compared with T1 when no significant difference (P> 0 .05) ;T4 group B CD3 ,CD4 ,CD4 / CD8 ,CD14 and CD25 significantly higher than that in group A ; ③ When the T4 group C CD3 ,CD4 ,CD4 / CD8 ,CD14 and CD25 increased significantly in the B group .Conclusion :Intravenous tramadol post‐operative analgesia inhibiting immune cell surface antigen and the receptor expression is lighter morphine ,prompt tramadol is more suitable for postoperative analgesia ,to give a guidance of clinical .