Objective To investigate the effects of epidural analgesia and intravenous analgesia on immune function,stress status and inflammatory cytokines in patients with ovarian neoplasm.Methods A total of 60 ovarian cancer patients who were treated in Maternal and Child Health Hospital of Shiyan from January 2013 to December 2016 were selected and divided into the epidural group and the intravenous group according to random number table method, with 30 cases in each group,which were respectively treated with epidural analgesia and intravenous analgesia.The oper-ating time, blood loss, and length of hospital stay of the two groups were recorded and compared. The levels of cortisol (CRH), adrenocorticotropic hormone (ACTH), growth hormone (GH) and prostaglandin E2 (PGE2) and serum hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were measured before operation and on the 1st, 3rd, 7th after operation. CD3+, CD4+, CD8+, and natural killer (NK) cells were detected by flow cytometry before operation and on the third day after surgery. Results There was no significant difference in average operation time, mean intraoperative blood loss, and average length of hospital stay between the two groups (P>0.05). The levels of CRH, GH and PGE2 on the 1st, 3rd, 7th day after operation in the epidural group were significantly lower than those in the intravenous group (P<0.05), but the ACTH was slightly lower than that in the intravenous group (P>0.05). The levels of IL-6, TNF-α and hs-CRP on the 1st, 3rd, 7th day in the epidural group were significantly lower than those in the intravenous group (P<0.05). There was no significant difference in the ratio of CD3+, CD4+, CD8+, CD4+/CD8+ and NK cells between the epidural and intravenous groups before surgery (P>0.05). Compared with before operation, the ratios of CD3+, CD4+, CD4+/CD8 + and NK cells in the epidural and intravenous groups were significantly decreased on the 3rd day after operation (P<0.05), while the number of CD8+ cells increased significantly (P<0.05). The levels of CD3+ ,CD4 +, CD4+/CD8 + and NK cells in the epidural group were significantly higher than those in the intravenous group (P< 0.05), while the percentage of CD8+ cells in the epidural group was significantly lower than that in the intravenous group(P<0.05). Conclusion Compared with intravenous analgesia, epidural analgesia can reduce the stress response and inflammatory status of patients for ovarian cancer surgery with less impact on immune function in patients.%目的 探讨硬膜外镇痛及静脉镇痛对卵巢肿瘤减灭术患者免疫功能、应激状态和炎性因子的影响.方法 将十堰市妇幼保健院2013年1月至2016年12月收治的60例卵巢癌手术患者采用随机数表法分为硬膜外组和静脉组各30例,硬膜外组采用硬膜外镇痛,静脉组采用静脉镇痛.比较两组患者的手术时间、术中出血量以及住院时间.测定并比较两组患者术前及术后1 d、3 d、7 d皮质醇(CRH)、促肾上腺皮质激素(ACTH)、生长激素(GH)和前列腺素E2(PGE2)水平和血清超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平.术前及术后第3天用流式细胞仪检测CD3+、CD4+、CD8+和NK细胞并进行比较.结果 两组患者平均手术时间、术中平均出血量及平均住院时间比较差异均无统计学意义(P>0.05).硬膜外组患者术后第1天、第3天、第7天的CRH、GH和PGE2水平明显低于静脉组,差异均有统计学意义(P<0.05),ACTH略低于静脉组,但差异无统计学意义(P>0.05);硬膜外组患者术后第1天、第3天、第7天的IL-6、TNF-α和hs-CRP水平明显低于静脉组,差异均有统计学意义(P<0.05);手术前硬膜外组和静脉组患者CD3+、CD4+、CD8+、CD4+/CD8+比值及NK细胞差异无统计学意义(P>0.05).与术前相比,硬膜外组及静脉组术后第3天CD3+、CD4+、CD4+/CD8+比值及NK细胞明显降低,差异有统计学意义(P<0.05),CD8+细胞显著升高,差异有统计学意义(P<0.05).硬膜外组术后CD3+、CD4+、CD4+/CD8+及NK细胞与静脉组相比明显升高,差异有统计学意义(P<0.05),CD8+细胞较静脉组相比明显降低,差异具有统计学意义(P<0.05).结论 与静脉镇痛相比,硬膜外镇痛能够减轻卵巢癌手术患者的应激反应和炎性状态,且对患者免疫功能影响较小.
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