摘要
目的 比较地佐辛与芬太尼术后镇痛时妇科恶性肿瘤患者的细胞免疫功能.方法 选择择期妇科恶性肿瘤手术患者50例,ASA分级Ⅰ或Ⅱ级,年龄18～70岁,体重50～ 80 kg,采用随机数字表法,将其分为2组（n=25）：地佐辛组（D组）和芬太尼组（F组）.均采用全凭静脉麻醉,术中麻醉用药相同.术毕采用PCIA,D组PCIA配方为地佐辛0.8 mg/kg加托烷司琼6 mg,F组PCIA配方为芬太尼0.01 mg/kg加托烷司琼6 mg.2组PCIA均用生理盐水配成总量为100 ml,负荷剂量2ml,背景输注速率2 ml/h,PCA剂量1 ml,锁定时间15 min.采用静脉注射曲马多100 mg补救镇痛,维持VAS评分≤4分.于术前（T0）、术毕（T1）、术后24（T2）和48 h（T3）时抽取静脉血样,采用流式细胞仪测定T淋巴细胞亚群CD3＋、CD4＋、CD8＋和NK细胞水平,计算CD4＋/CD8＋比值.记录术后补救镇痛情况和不良反应（恶心、呕吐、低血压、呼吸抑制）的发生情况.结果 2组均未使用曲马多补救镇痛.与T0时比较,D组T12时CD3＋、CD4＋、CD4＋/CD8＋比值、NK细胞水平降低,T1时CD8＋水平升高;F组T1,2时CD3＋、T1时CD4＋、T1-3时NK细胞水平降低（P＜0.05）,CD8＋和CD4＋/CD8＋比值差异无统计学意义（P＞0.05）.与F组比较,D组T3时CD3＋和NK细胞水平升高（P＜0.05）,术后不良反应发生率差异无统计学意义（P＞0.05）.结论 与芬太尼术后镇痛时比较,地佐辛术后镇痛时妇科恶性肿瘤患者细胞免疫功能抑制程度减轻.
[ Abstract] Objective To compare the cellular immune function during postoperative analgesia with dezocine and fentanyl in the patients with gynecologic malignant tumors. Methods Fifty patients scheduled for elective surgery for gynecologic malignant tumors, of American Society of Anesthesiologists physical status I or Ⅱ , were equally and randomly divided into either dezocine group （group D） or fentanyl group （ group F） using a random number table. Total intravenous anesthesia was used for all the patients, and the intraoperatively administered anesthetics was the same. The patient-controlled intravenous analgesia （PCIA） was used for postoperative analgesia. PCIA solution contained dezocine 0.8 mg/kg and tropisetron 6 mg in 100 ml of normal saline in group D. PCIA solution contained fentanyl 0.01 mg/kg and tropisetron 6 mg in 100 ml of normal saline in group F. The PCA pump was set up to deliver a 1 ml bolus dose with a 15- min lockout interval and background infusion at 2 ml/h after a loading dose of 2 ml in the two groups. Tram- adol 100 mg was given intravenously as rescue analgesic to maintain visual analogue scale score≤4. Before surgery （To） , at the end of surgery, and at 24 and 48 h after surgery （ T2.3 ） , venous blood samples were collected for detection of T lymphocyte subsets CD3＋, CD4＋, CD8＋ and natural killer （NK） cell levels （by flow cytometry）. CD4＋/CD8＋ ratio was calculated. The requirement for rescue analgesics and occur- rence of adverse reactions such as nausea, vomiting, hypotension and respiratory expression were recordedafter surgery. Results No patients required tramadol as rescue analgesic in either group. Compared with the value at TO , the levels of CD3＋ , CD4＋ and NK ceils and CD4＋/CD8＋ ratio were significantly decreased at T1,2, and the CD8＋level was increased at T1 in group D, and the levels of CD3＋ cells at T1,2, CD4＋ cells at Tl and NK cells at T1-3 were decreased （P〈0.05） , and no significant change was found in CD8＋ cell level and CD4＋/CD8＋ ratio in group F （P〉0.05）. Compared with group F, the levels of CD3＋ and NK cell were significantly increased at T3 （P〈0.05） , and no significant change was found in the incidence of adverse reactions after surgery in group D （P〉0. 05）. Conclusion The inhibitory degree of the cellular immune function is reduced when postoperative analgesia is performed with dezocine as compared with that when fentanyl is used in the patients with gynecologic malignant tumors.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2015年第11期1293-1295,共3页
Chinese Journal of Anesthesiology
关键词
镇痛药
阿片类
芬太尼
镇痛
病人控制
免疫
细胞
Analgesics, opioid
Fentanyl
Analgesia, patient-controlled
Immunity, cellular
