| Objective: Comparing the effects of three different analgesic models on postoperative immune function and stress response in patients with open inguinal hernia surgery,to explore the best analgesic model for patients.The surgeon and anesthesiologists can choose the safer,more comfortable and more effective analgesia model for patients.Methods:A total of 60 patients with unilateral inguinal hernia in the Second Hospital of Hebei Medical University from Apr 2016 to Jan.2017 participated in the study,including 57 males and 3 females.The patients are randomly divided into the group A which analgesia were taken only the patients demand after operation,the group B which analgesia were taken in predetermined fixed time after operation and the C group which analgesia were taken before surgery and in predetermined fixed time after operation.We infiltrated the mixture of ropivacaine and lidocaine into the wound at the end of operation for all the patients.In our study,the flurbiprofen was the only analgesic for all the patients by the mainline.Surgical methods were tension-free inguinal hernia repaire(Millikan),and we only used the partially absorbable mesh for the patients.Comparison the index’ changes of the three groups was observed before and after the surgery.Visual analogy scores(VAS)of 1 hour before operation and at postoperative 4h,8h,12 h,24h,48 h were recorded.The monitoring indicators: white blood cell(WBC),lymphocyte absolute value(LY),neutrophil absolute value(Neu),mononuclear cells(Mono)and interleukin-6(IL-6)were taken notes.CD4 +,CD8 + and CD4 + / CD8 + were observed at preoperation and postoperation.The WBC,LY,Neu and Mono were measured by VCS technique in automatic blood cell analyzer.CRP weremeasured by immunity turbidity assay.IL-6 were measured by double antibody sandwich enzyme-linked immunosorbent assay(ELISA).Percentage of T-lymphocyte subsets were analyzed by flow cytometry technology.Test datas were analyzed by SPSS19.0.P <0.05 is considered statistically significant.Results:VAS score: At preoperative 1 h,the VAS score between the three teams were no statistically significant and the score were all zero.During all the postoperative time we recorded,VAS score in group B and group C were significantly lower than those in group A(P<0.05).At postoperative 8h,12 h and 24 h,VAS score in group C were significantly lower than those in group B(P<0.05).WBC: There is no statistical significance about WBC level in the comparison of group A,group B and group C before the operation(P>0.05).The level of WBC in group B and C were significantly lower than those in group A(P< 0.05),while the WBC level in group C were significantly lower than those in group B(P<0.05).Neutrophil: Before surgery,the Neutrophil level between the three teams were no statistically significant.the Neutrophil level in group B and C were significantly lower than those in group A(P<0.05),while the ones in group C were significantly lower than those in group B(P<0.05).LY: There were no statistical significance about the LY level in the three groups before the operation and after the surgery(P> 0.05).Mononuclear: The mononuclear cells in the three teams were no statistical significance before the operation.The level of mononuclear cells in group B and C were significantly lower than those in group A(P<0.05)after the surgery,while the mononuclear cells in group C were significantly lower than those in group B(P<0.05).CRP: There is no statistical significance on the C-reactive protein level between the three groups before the operation.While the comparison of the C-reactive protein level in group A,B and C after operation are statisticallysignificant(P <0.05).The levels of C-reactive protein in group A is significantly higher than the others after operation(P<0.05).And C-reactive protein of the group B was higher than the group C(P<0.05).IL-6: There were no statistical significance about the Interleukin 6 level in the three groups before the operation and after the surgery(P> 0.05).But the Interleukin-6 level of all the patients after surgery were higher than those before the surgery.CD4+: Before operation,the differences of CD4+ between the three teams were not statistically significant(P> 0.05).The team A and B were notably lower than the other on CD4+ after surgery(P< 0.05).But there is no difference between team B and team A after surgery.However,the value of CD4+ in the group A and B after operation was significantly lower than that before surgery.CD8+: There were no statistical significance about the CD8+ in the three groups before the operation and after the surgery(P> 0.05).CD4+/CD8+: Before operation,the differences of CD4+/CD8+ between the three teams were not statistically significant(P> 0.05).The team A was notably lower than the two other teams on CD4+/CD8+ after surgery(P <0.05).But there is no difference between team B and team C after operation.The value of CD4+/CD8+ in the group A after operation was significantly lower than that before surgery.Conclusion:Compared with group A and B,the Group C(preoperative intravenous flurbiprofen,ropivacaine combined with lidocaine incision infiltration at the end of operation and postoperative intravenous flurbiprofen in predetermined fixed time after surgery)effectively relieved postoperative pain,protected the immune function and reduced inflammation and stress response. |
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