Effects Of Different Analgesic Techniques On The Stress Response And Cell Immunity In Patients Undergoing Lung Cancer Surgeries

Objective To observe the effects of different analgesic methods on the stress responseand immune functions in patients undergoing lung cancer surgeries. MethodsThirty-one ASAⅠ～Ⅱpatients undergoing elective lung cancer surgeries undergeneral anesthesia were randomly allocated into two groups, groupE (n=15)received PCEA with 0.125ï¼…bupivacaine 210ml. (1ml contained fentany 2.4ug+midazolam 0.05mg) background infusion4ml, PCA 1ml, lock-out interval 20min.groupâ… received PCIA with fentany20ug/ml,. midazolam 0.1mg/ml, tropisetron 0.04mg/mlbackground infusion 2ml PCA 1ml, lock-out interval 20min. The analgesic andsedative efficacy were evaluate by visual analog scale(VAS) and Remesay (RSS)respectively. Peripheral blood samples were taken at 6 time points ,which were beforeinduction of anesthesia, two hours, the frist, the third, the fifth and the seventh dayafter surgeries in the morning. Expressions of T-lymphocyte subsets (CD3+', CD4+,CD8+, CD4+/CD8+), NK, CIK, interlukin-2, intedukin-4, interlukin-5,interlukin-10, interferon-ν, tumor necrosis-α, cortisol levels were determinedMain Results There were no significant difference in age, body height, body weight,ASA class, bleeding time, and surgical duration between the two groups. Pain relief wassimilar both in groups, but the RSS was higher in group I. (P＜0.05). All the cases ingroupE, showed an obvious decrease of percentages of CD3+, CD4+, CD8+ at 2hpostoperatively.(P＜0.05)and almost returned to baseline values on the 7thpostoperative day., The NK cell activity increased 2h after anesthesia and cytokineinduced killer cell increased significantly on the third postoperative day. In groupI, The percentages of CD3⁺was declined after two hours postoperatively and almostreturned to baseline values on the first postoperative day., The percentages of CD₄⁺decreased significantly on seven days postoperatively. (P＜0.05)The NK cell activityand cik were decreased, There was statistical difference in CIK concentration betweentwo groups in the frist, the third and the seventh day after operation (P＜0.05) Thecontents of CIK in groupE was markedly higher than those in groupI. The level ofCD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺, NK ceils had no important differencebetween two groups. cortisol level in two groups was increased significantly at 2hpostoperatively compared with before operation (P＜0.05)and it had importantdifference between two groups(P＜0.05). Meanwhile, a significant difference betweentwo groups was noted for the pro-inflammatory cytokines concentrations of TNF-a on the fifth postoperative day. On the other hand, anti-inflammatory cytokinesIL-10 increasd at 2h postoperatively in two groups. Plasma concentrations of Th1-type cytokine, (IL-2, IFN-ν)were decreased strikingly at 2h postoperatively(P＜0.05)and Th2-type cytokine IL-5 increasd at 2h postoperatively in two groups.(P＜0.05) IL-4were similar in the two groups at all time points(P＞0.05).In lung cancerpatients, cortisol was negatively correlated with the T-lymphocyte subsets. ConclusionFor all patients undergoing lung cancer surgeries, the epidural has same analgesiaefficacy, less immunity depression and less stress response than intravenous analgesia...