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。%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 .
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