肝癌患者術(shù)后疼痛對細胞免疫功能及早期預(yù)后的影響
發(fā)布時間：2018-08-30 18:12
【摘要】：背景與目的原發(fā)性肝癌(Primary liver cancer,PLC)是目前世界范圍內(nèi)最常見惡性腫瘤之一。近年來雖然乙肝病毒感染患者的發(fā)病率明顯下降,但原發(fā)性肝癌的總體新發(fā)病率及死亡率仍呈明顯增長趨勢,而原發(fā)性肝癌的總體生存率沒有明顯提高。手術(shù)切除是肝癌診治的首選方式,但手術(shù)創(chuàng)傷大,疼痛是患者術(shù)后最主要的主訴之一,且術(shù)后幾天內(nèi)機體的免疫功能明顯變差,早期預(yù)后差異較大。術(shù)后疼痛對機體免疫功能和早期預(yù)后有無影響尚不明確,本文收集了南方醫(yī)院近2年肝癌術(shù)后病例,探討術(shù)后疼痛與患者細胞免疫及早期預(yù)后的關(guān)系,為原發(fā)性肝癌術(shù)后快速康復(fù)模式選擇提供依據(jù)。方法收集2014年6月至2016年10月90例在南方醫(yī)院肝膽外科行肝癌切除術(shù)患者的臨床病理資料。按照數(shù)字等級評分法對患者疼痛進行評分分組,將術(shù)后0—7天內(nèi)NRS≤3(Numerical rating scal,數(shù)字等級評分)分為有效鎮(zhèn)痛組(n=51例),NRS3分為無效鎮(zhèn)痛組(n=39例).通過回顧性分析兩組患者術(shù)前肝功能、血常規(guī)、手術(shù)切口長度、腫瘤部位、最大直徑、術(shù)后肝功能及細胞免疫功能變化等臨床病理資料并觀察術(shù)后相關(guān)并發(fā)癥、器官功能恢復(fù)等指標變化情況,對比分析兩組患者各指標組間及組內(nèi)差異性、預(yù)后情況及其臨床意義。結(jié)果1.肝癌術(shù)后疼痛第1天最劇烈,第5天后程度減輕,有效鎮(zhèn)痛治療明顯減輕疼痛程度。兩組在年齡、體重指數(shù)等一般情況及術(shù)前血清丙氨酸氨基轉(zhuǎn)移酶(alanine aminotransferase,ALT)、天門冬氨酸氨基轉(zhuǎn)移酶(aspartate aminotransferase,AST)、血清總膽紅素(total bilirubin,TB)、白蛋白(albumin,ALB)及凝血酶原時間(prothrombintime,PT)等肝功能參數(shù)及營養(yǎng)指標等方面均無顯著差異性。2.兩組患者在手術(shù)切口長度、腫瘤大小、手術(shù)時間、腫瘤位置,是否進行肝門阻斷、肝斷面縫扎、術(shù)中出血量、術(shù)中輸血情況及麻醉方式、腫瘤病理類型、是否有淋巴結(jié)轉(zhuǎn)移或門靜脈或脈管癌栓、腫瘤TNM分期及病理分化程度等病理資料差異無顯著差異。3.兩組患者術(shù)前、術(shù)后ALT、AST、TBIL、PT、ALB水平相比具有顯著差異(P0.05);且有效鎮(zhèn)痛組ALT、AST、TBIL、PT上升或延長幅度均明顯低于無效鎮(zhèn)痛組。術(shù)后第5天ALB水平明顯高于無效鎮(zhèn)痛組,但術(shù)后第1天、第3天及第7天ALB水平及術(shù)后血紅蛋白水平無顯著差異(P0.05)。4.有效鎮(zhèn)痛組術(shù)后總并發(fā)癥發(fā)生率、肝功能恢復(fù)延遲、肺炎、腸梗阻、睡眠不良等并發(fā)癥明顯低于無效鎮(zhèn)痛組,且術(shù)后首次肛門排氣時間、首次下床活動時間)、首次進食時間、腹腔引流管放置時間、住院天數(shù)均少于無效鎮(zhèn)痛組,差異具有統(tǒng)計學(xué)意義(p0.05)。5.兩組患者靜脈血CD3+T、CD4+T的表達及CD4+/CD8+比值顯著低于正常值,而CD8+T細胞表達水平高于正常人,且兩組患者術(shù)后血清CD3+T細胞、CD4+T細胞、CD8+T細胞及CD4+/CD8+比比比值與術(shù)前相比及術(shù)后同期相比,有效鎮(zhèn)痛組免疫功能明顯優(yōu)于無效效鎮(zhèn)痛組,差異均具有統(tǒng)計學(xué)意義(P0.05)。結(jié)論1.有效鎮(zhèn)痛可顯著減輕肝癌患者術(shù)后肝功能損害,促進肝功能盡快恢復(fù)。2.CD4+/CD8+比值反應(yīng)患者免疫功能平衡狀態(tài)的敏感指標,肝癌患者存在不同程度的免疫功能抑制,肝癌切除術(shù)進一步加重肝癌患者機體免疫功能損害,而有效鎮(zhèn)痛治療對免疫功能具有保護作用,鎮(zhèn)痛效果越好,對免疫功能的保護作用越佳。3.持續(xù)有效鎮(zhèn)痛治療可加速各器官功能恢復(fù)、縮短住院時間及減少醫(yī)療費用,提高肝癌術(shù)后患者治療療效。4.我們可以通過術(shù)后有效鎮(zhèn)痛治療減輕患者應(yīng)激反應(yīng)程度及痛苦、減少術(shù)后并發(fā)癥,加速患者快速康復(fù)而改善患者預(yù)后。
[Abstract]:BACKGROUND & OBJECTIVE Primary liver cancer (PLC) is one of the most common malignant tumors in the world at present. Although the incidence of hepatitis B virus infection has decreased significantly in recent years, the overall incidence and mortality of primary liver cancer are still increasing significantly, while the overall survival rate of primary liver cancer is not significantly improved. Surgical resection is the first choice for the diagnosis and treatment of hepatocellular carcinoma, but surgical trauma and pain is one of the main complaints of the patients after operation. The immune function of the body becomes worse within a few days after operation, and the early prognosis varies greatly. Objective To investigate the relationship between postoperative pain and cellular immunity and early prognosis of patients with primary hepatocellular carcinoma (PHC) and to provide evidence for choosing the mode of rapid postoperative rehabilitation. The patients were divided into effective analgesia group (n = 51 cases) and ineffective analgesia group (n = 39 cases). The preoperative liver function, blood routine, surgical incision length, tumor location, maximum diameter, postoperative liver function and cellular immune function were analyzed retrospectively. The clinical and pathological data, such as postoperative complications, organ function recovery and other indicators were observed, and the differences between the two groups were compared. The prognosis and clinical significance were analyzed. Results 1. The postoperative pain of hepatocellular carcinoma was the most severe on the first day, the degree of relief after the fifth day. Age, body mass index, preoperative serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum total bilirubin (TB), albumin (ALB), prothrombin time (PT) and other liver function parameters and nutrition There was no significant difference in the length of incision, tumor size, operation time, tumor location, hepatic portal obstruction, suture of hepatic section, intraoperative blood loss, intraoperative blood transfusion and anesthesia, pathological type of tumor, lymph node metastasis or portal vein or vascular tumor thrombus, TNM staging and pathology. The ALT, AST, TBIL, PT and ALB levels in the effective analgesia group were significantly lower than those in the ineffective analgesia group. There was no significant difference in ALB level and postoperative hemoglobin level (P 0.05). 4. The incidence of postoperative complications, delayed recovery of liver function, pneumonia, intestinal obstruction, poor sleep and other complications in the effective analgesia group were significantly lower than those in the ineffective analgesia group. The expression of CD3 + T, CD4 + T and the ratio of CD4 + / CD8 + in the venous blood of the two groups were significantly lower than the normal value, while the expression of CD8 + T cells was higher than that of the normal people, and the ratio of CD3 + T cells, CD4 + T cells, CD8 + T cells and CD4 + / CD8 + in the serum of the two groups was significantly lower than that of the preoperative patients. Compared with the same period after operation, the immune function of the effective analgesia group was significantly better than that of the ineffective analgesia group, the difference was statistically significant (P 0.05). Conclusion 1. Effective analgesia can significantly reduce the liver function damage and promote the recovery of liver function as soon as possible. 2. CD4 + / CD8 + ratio reflects the sensitive index of immune function balance in patients with liver cancer. Patients with liver cancer have different degrees of immunosuppression. Hepatectomy further aggravates the impairment of immune function in patients with liver cancer. Effective analgesic therapy has a protective effect on immune function. The better the analgesic effect, the better the protective effect on immune function. 3. Continuous and effective analgesic treatment can accelerate the recovery of organ function, shorten hospital stay and 4. We can reduce the degree of stress reaction and pain, reduce postoperative complications, accelerate the recovery of patients and improve the prognosis of patients by effective postoperative analgesia.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.7
[Abstract]:BACKGROUND & OBJECTIVE Primary liver cancer (PLC) is one of the most common malignant tumors in the world at present. Although the incidence of hepatitis B virus infection has decreased significantly in recent years, the overall incidence and mortality of primary liver cancer are still increasing significantly, while the overall survival rate of primary liver cancer is not significantly improved. Surgical resection is the first choice for the diagnosis and treatment of hepatocellular carcinoma, but surgical trauma and pain is one of the main complaints of the patients after operation. The immune function of the body becomes worse within a few days after operation, and the early prognosis varies greatly. Objective To investigate the relationship between postoperative pain and cellular immunity and early prognosis of patients with primary hepatocellular carcinoma (PHC) and to provide evidence for choosing the mode of rapid postoperative rehabilitation. The patients were divided into effective analgesia group (n = 51 cases) and ineffective analgesia group (n = 39 cases). The preoperative liver function, blood routine, surgical incision length, tumor location, maximum diameter, postoperative liver function and cellular immune function were analyzed retrospectively. The clinical and pathological data, such as postoperative complications, organ function recovery and other indicators were observed, and the differences between the two groups were compared. The prognosis and clinical significance were analyzed. Results 1. The postoperative pain of hepatocellular carcinoma was the most severe on the first day, the degree of relief after the fifth day. Age, body mass index, preoperative serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum total bilirubin (TB), albumin (ALB), prothrombin time (PT) and other liver function parameters and nutrition There was no significant difference in the length of incision, tumor size, operation time, tumor location, hepatic portal obstruction, suture of hepatic section, intraoperative blood loss, intraoperative blood transfusion and anesthesia, pathological type of tumor, lymph node metastasis or portal vein or vascular tumor thrombus, TNM staging and pathology. The ALT, AST, TBIL, PT and ALB levels in the effective analgesia group were significantly lower than those in the ineffective analgesia group. There was no significant difference in ALB level and postoperative hemoglobin level (P 0.05). 4. The incidence of postoperative complications, delayed recovery of liver function, pneumonia, intestinal obstruction, poor sleep and other complications in the effective analgesia group were significantly lower than those in the ineffective analgesia group. The expression of CD3 + T, CD4 + T and the ratio of CD4 + / CD8 + in the venous blood of the two groups were significantly lower than the normal value, while the expression of CD8 + T cells was higher than that of the normal people, and the ratio of CD3 + T cells, CD4 + T cells, CD8 + T cells and CD4 + / CD8 + in the serum of the two groups was significantly lower than that of the preoperative patients. Compared with the same period after operation, the immune function of the effective analgesia group was significantly better than that of the ineffective analgesia group, the difference was statistically significant (P 0.05). Conclusion 1. Effective analgesia can significantly reduce the liver function damage and promote the recovery of liver function as soon as possible. 2. CD4 + / CD8 + ratio reflects the sensitive index of immune function balance in patients with liver cancer. Patients with liver cancer have different degrees of immunosuppression. Hepatectomy further aggravates the impairment of immune function in patients with liver cancer. Effective analgesic therapy has a protective effect on immune function. The better the analgesic effect, the better the protective effect on immune function. 3. Continuous and effective analgesic treatment can accelerate the recovery of organ function, shorten hospital stay and 4. We can reduce the degree of stress reaction and pain, reduce postoperative complications, accelerate the recovery of patients and improve the prognosis of patients by effective postoperative analgesia.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.7
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