硬膜外自控镇痛对下肢骨肿瘤患者术后下肢微循环及T淋巴细胞亚群的影响

摘要

目的 研究硬膜外自控镇痛对下肢骨肿瘤患者术后下肢微循环及T淋巴细胞亚群的影响.方法 选取下肢骨肿瘤行择期手术患者108例,参考随机数字表法,按照1:1比例将纳入者随机分为观察组和对照组,各54例.两组患者采用同样的麻醉方法,术后镇痛观察组采用硬膜外自控镇痛、对照组采用静脉自控镇痛.且于术后4 h、24 h、48 h观察两组患者疼痛程度,麻醉前30 min、切皮后2 h、术后4 h、24 h、48 h免疫功能指标(CD4+、CD8+、计算CD4+/CD8+比值)以及术前、术后48 h踝肱指数(ABI)、足背动脉血流量;术后首次排便、排气时间.结果 术后4 h、48 h,观察组VAS评分与对照组比较,差异无统计学意义(P>0.05).术后24 h,观察组VAS评分低于对照组,差异有统计学意义(P<0.05).术后48 h,观察组ABI、足背动脉血流量高于对照组,差异均有统计学意义,(P<0.05).麻醉前30 min、切皮后2 h,观察组CD4+、CD4+/CD8+比值与对照组比较,差异无统计学意义(P>0.05).术后4 h、24 h、48 h,CD4+、CD4+/CD8+比值高于对照组,差异有统计学意义(P<0.05).结论 硬膜外自控镇痛能减轻下肢骨肿瘤患者术后疼痛,降低下肢微循环异常风险、减轻细胞免疫抑制,有助于保证患者平稳渡过手术危险期、促进其早日康复.且凭借其可控性及灵活性强等优势,值得推广.%Objective To study the effect of epidural analgesia on lower extremity microcirculation and T lymphocyte subsets in patients with lower extremity bone tumor.Methods 108 patients undergoing elective surgery were selected.The ran-dom number table method was randomly divided into the observation group and the control group according to the ratio of 1:1. The 2 groups of patients using the same anesthesia,postoperative analgesia of the observation group using epidural analgesia,the control group using intravenous analgesia.(CD4+,CD8+,CD4 +/CD8+ratio)and preoperative,intraperitoneal and postoperative levels of the 2 groups were observed at 4h,24h and 48h after operation.The levels of CD4+,CD8+,CD4 +/CD8+48 hours after ankle brachial index(ABI),dorsalis pedis artery blood flow;postoperative defecation,exhaust time.Results There was no sig-nificant difference between the observation group and the control group at 4 hours and 48 hours after operation(P>0.05).After 24 hours,the VAS score of the observation group was lower than that of the control group,the difference was statistically signifi-cant(P<0.05).At 48 h after operation,the blood flow of ABI and dorsalis pedis artery in the observation group was higher than that of the control group,the difference was statistically significant(P<0.05).There was no significant difference in CD 4+, CD4+/CD8+ratio between the 2 groups before and after implantation(P>0.05).The ratio of CD4+,CD4+/CD8+was higher than that of the control group at 4h,24h and 48h after operation(P<0.05).Conclusion Epidural analgesia can reduce the postoperative pain,reduce the risk of lower extremity microcirculation and reduce the immunosuppression of the patients with low -er extremity bone tumor,and help to ensure the smooth survival of the patients and promote the early recovery.And by virtue of its controllability and flexibility and other advantages,it is worth promoting.