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目的探究多模式镇痛对老年胃癌患者术后T淋巴细胞亚群及Th细胞分化的影响。方法 60例老年胃癌手术患者,采用随机数表法分为观察组和对照组,各30例。对照组采用芬太尼进行镇痛,观察组采用多模式镇痛方式,比较两组镇痛效果。结果观察组和对照组在术后2、24、48 h的视觉模拟评分法(VAS)评分比较差异无统计学意义(P>0.05)。两组术后1 d CD3+、CD4+均低于术前,差异有统计学意义(P<0.05);而7 d后又有所回升,与术前比较差异无统计学意义(P>0.05);两组术后1 d和7 d的CD8+指标高于术前,差异有统计学意义(P<0.05)。对照组在术后1 d的CD3+、CD4+减少的幅度要低于观察组,且CD8+细胞增多的幅度也高于观察组,差异有统计学意义(P<0.05)。术后7 d,对照组CD3+、CD4+增加幅度低于观察组,CD8+增加幅度高于观察组,差异有统计学意义(P<0.05)。手术前,两组患者Th1、Th2细胞含量比较差异无统计学意义(P>0.05);术后,观察组的Th1的细胞含量为(11.3±1.5)%高于对照组的(7.3±1.6)%,观察组Th2细胞含量为(4.9±0.7)%,Th1/Th2为(2.3±0.3)均低于对照组的(7.9±0.9)%、(2.9±0.1),差异均有统计学意义(P<0.05)。结论多模式镇痛对老年胃癌患者术后T淋巴细胞亚群及Th细胞分化的影响要优于普通的单一镇痛方式。
Objective To investigate the effect of multimodal analgesia on T lymphocyte subsets and Th cell differentiation in elderly patients with gastric cancer. Methods Sixty elderly gastric cancer patients undergoing surgery were divided into observation group and control group by random number table, with 30 cases in each group. The control group was treated with fentanyl for analgesia, and the observation group used multimodal analgesia. The analgesic effects of the two groups were compared. Results There was no significant difference in visual analog scale (VAS) score between the observation group and the control group at 2, 24, 48 h after operation (P> 0.05). The CD3 + and CD4 + values of the two groups were significantly lower than those before operation (P <0.05), and recovered on the 7th day after operation. There was no significant difference between the two groups (P> 0.05). The indexes of CD8 + on the 1st and 7th day after operation in both groups were significantly higher than those before operation (P <0.05). The decrease of CD3 + and CD4 + in the control group at 1 day after operation was lower than that of the observation group, and the increase of CD8 + cells was also higher than that of the observation group (P <0.05). At 7 days after operation, the increase of CD3 + and CD4 + in the control group was lower than that in the observation group, and the increase of CD8 + in the control group was higher than that in the observation group. The difference was statistically significant (P <0.05). Th1 and Th2 cells in the two groups had no significant difference before surgery (P> 0.05). After operation, the content of Th1 in the observation group was (11.3 ± 1.5)% higher than that in the control group (7.3 ± 1.6) %, The level of Th2 cells in the observation group was (4.9 ± 0.7)% and that of Th1 / Th2 was (2.3 ± 0.3) was lower than that of the control group (7.9 ± 0.9)% and (2.9 ± 0.1) respectively P <0.05). Conclusion The effect of multimodal analgesia on postoperative T lymphocyte subsets and Th cell differentiation in elderly patients with gastric cancer is better than that of common single analgesia.