摘要
目的:探讨单孔与三孔胸腔镜肺癌根治术对疼痛反应、应激反应、炎症反应及免疫功能的影响。方法:选择2018年1月~2019年1月我院收治的112例肺癌患者作为研究对象,根据手术方式分为单孔组(54例)和三孔组(58例),单孔组行单孔胸腔镜肺癌根治术,三孔组行三孔胸腔镜肺癌根治术。比较两组患者的前列腺素E2(PGE2)、多巴胺(DA)、5-羟色胺(5-HT)、皮质醇(Cor)、促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)、C反应蛋白(CRP)、降钙素原(PCT)、CD3+、CD4+、CD8+、CD4+/CD8+水平。结果:术前,两组患者各项指标均无统计学差异;术后24h,单孔组的PGE2、DA、5-HT水平分别为(183.70±21.81)pg/m L、(22.72±3.16)ng/L、(0.64±0.07)μmol/m L,三孔组的PGE2、DA、5-HT水平分别为(197.81±23.24)pg/m L、(42.85±5.99)ng/L、(0.94±0.10)μmol/m L,两组患者的PGE2、DA、5-HT均比术前升高,且三孔组较单孔组更高。术后24h,单孔组的Cor、NE分别为(96.58±22.18)ng/m L、(2.83±0.24)pg/m L,三孔组的Cor、NE分别为(117.29±26.17)ng/m L、(4.73±0.58)pg/m L,两组患者的Cor、NE均比术前升高,且三孔组较单孔组更高;两组患者的ACTH无显著变化。术后24h,单孔组的CRP、PCT分别为(30.58±6.18)mg/L、(4.10±0.48)ng/m L,三孔组的CRP、PCT分别为(40.29±7.51)mg/L、(6.31±0.91)ng/m L,两组患者的CRP、PCT均比术前升高,且三孔组较单孔组更高。术后24h,单孔组的CD3+、CD4+、CD4+/CD8+分别为(63.00±4.45)%、(33.45±7.01)%、(1.41±0.44),三孔组的CD3+、CD4+、CD4+/CD8+分别为(57.10±4.23)%、(28.01±7.23)%、(1.30±0.57),两组患者的CD3+、CD4+、CD4+/CD8+均比术前降低,且三孔组较单孔组更低;两组患者的CD8+无显著变化。结论:与三孔胸腔镜手术相比,单孔胸腔镜手术能够更显著的减轻疼痛反应、应激反应、炎症反应以及对免疫功能的影响。
Objective To investigate the effects of single-port and three-port thoracoscopic radical resection of lung cancer on pain response,stress response,inflammatory response and immune function.Methods 112 patients with lung cancer admitted to our hospital from January 2018 to January 2019 were selected as the study subjects.They were divided into single-hole group(54 cases)and three-hole group(58 cases)according to the operation methods.Single-hole thoracoscopic radical resection of lung cancer was performed in the single-hole group,and three-hole thoracoscopic radical resection of lung cancer was performed in the three-hole group.The levels of prostaglandin E2(PGE2),dopamine(DA),5-hydroxytryptamine(5-HT),cortisol(Cor),adrenocorticotropic hormone(ACTH),norepinephrine(NE),C-reactive protein(CRP),procalcitonin(PCT),CD3+,CD4+,CD8+,CD4+/CD8+were compared between the two groups.Results Before operation,there were no significant differences in all indexes between the two groups.At 24 hours after operation,the levels of PGE2,DA and 5-HT in the single-hole group were(183.70±21.81)pg/mL,(22.72±3.16)ng/L,(0.64±0.07)μmol/m L,and those in the three-hole group were(197.81±23.24)pg/mL,(42.85±5.99)ng/L,(0.94±0.10)μmol/m L,respectively.The PGE2,DA and 5-HT of the two groups were higher than those before operation,and those in the three-hole group were higher than those in the single-hole group.At 24 hours after operation,the Cor and NE of the singlehole group were(96.58±22.18)ng/mL and(2.83±0.24)pg/mL,respectively.The Cor and NE of the three-hole group were(117.29±26.17)ng/mL and(4.73±0.58)pg/mL,respectively.Cor and NE were higher in the two groups than before the operation,and those in the three-hole group were higher than those in the single-hole group.There was no significant change in ACTH between the two groups.At 24 hours after operation,CRP and PCT in the single-hole group were(30.58±6.18)mg/L and(4.10±0.48)ng/m L,respectively,while those in the three-hole group were(40.29±7.51)mg/L and(6.31±0.91)ng/mL,respectively.The CRP and PCT of the two groups were higher than those before operation,and those in the three-hole group were higher than those in the single-hole group.At 24 hours after operation,CD3+,CD4+,CD4+/CD8+in the single-hole group were(63.00±4.45)%,(33.45±7.01)%,(1.41±0.44),and CD3+,CD4+,CD4+/CD8+in the three-hole group were(57.10±4.23)%,(28.01±7.23)%,(1.30±0.57),respectively.The CD3+,CD4+,CD4+/CD8+of the two groups were lower than those before operation,and those in the three-hole group were lower than those in the single-hole group.There was no significant change in CD8+between the two groups.Conclusion Compared with three-hole thoracoscopic surgery,single-hole thoracoscopic surgery can significantly reduce pain response,stress response,inflammatory response and the impact on immune function.
作者
董良超
肖兵容
喻红
Dong Liang-chao;Xiao Bing-rong;Yu Hong(Department of Cardiothoracic surgery,Tianmen First People’s Hospital,Tianmen 431700,China;Department of Imaging,Tianmen First People’s Hospital,Tianmen 431700,China;Outpatient Department,Maternal and Child Health Hospital of Tianmen City,Tianmen 431700,China)
出处
《湖南师范大学学报（医学版）》
2020年第1期129-132,共4页
Journal of Hunan Normal University(Medical Sciences)
关键词
单孔胸腔镜手术
疼痛介质
应激反应
炎症反应
免疫功能
single-hole thoracoscopic surgery
pain mediator
stress response
inflammatory response
immunity
作者简介
通讯作者:肖兵容,E-mail:504393125@qq.com
