右美托咪定联合舒芬太尼静脉自控镇痛用于食管癌患者术后镇痛的效果及对机体免疫功能的影响
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篇名: 右美托咪定联合舒芬太尼静脉自控镇痛用于食管癌患者术后镇痛的效果及对机体免疫功能的影响
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摘要: 目的:观察右美托咪定联合舒芬太尼静脉自控镇痛(PCIA)用于食管癌患者术后镇痛的效果及对机体免疫功能的影响。方法:选择2015年1月-2017年1月我院收治的120例食管癌患者,按随机数字表法分为对照组和观察组,每组60例。术后所有患者行PCIA,对照组患者PCIA药液为枸橼酸舒芬太尼注射液2 μg/(kg·d)+盐酸托烷司琼注射液15 mg+0.9%氯化钠注射液至100 mL;观察组患者PCIA药液为盐酸右美托咪定注射液0.75 μg/(kg·d)+枸橼酸舒芬太尼注射液2 μg/(kg·d)+盐酸托烷司琼注射液15 mg+0.9%氯化钠注射液至100 mL。两组患者PCIA背景剂量为2 mL/h,单次剂量为0.5 mL,锁定时间为15 min。观察两组患者术后疼痛视觉模拟评分(VAS),术前及术后血浆中干扰素γ(IFN-γ)、白细胞介素10(IL-10)、CD3+T细胞、CD4+T细胞、CD8+T细胞、CD4+/CD8+水平及不良反应发生情况。结果:观察组患者术后6、12、24、48 h的VAS评分均显著低于对照组同期(P<0.05),且随时间延长逐渐降低。两组患者术后6 h及对照组患者术后12、24、48 h血浆中IFN-γ水平均显著高于同组术前,而观察组术后6、12、24、48 h均显著低于对照组同期;两组患者术后12、24、48 h血浆中IL-10水平均显著高于同组术前,且观察组术后6、12、24、48 h均显著高于对照组同期(P<0.05)。对照组患者术后12、24、48 h血浆中CD3+T细胞水平均显著低于同组术前,而观察组术后6、12、24 h均显著高于对照组同期;两组患者术后12、24 h血浆中CD4+T细胞水平均显著低于同组术前,而观察组术后6、12、24 h均显著高于对照组同期;对照组患者术后24 h及观察组患者术后12、24 h血浆中CD8+T细胞水平均显著低于同组术前,且观察组术后12、24 h均显著低于对照组同期;对照组患者术后12、24 h血浆中CD4+/CD8+水平均显著低于同组术前,而观察组术后12、24 h均显著高于同组术前,且其术后6、12、24 h均显著高于对照组同期(P<0.05)。两组患者不良反应发生率比较差异无统计学意义(P>0.05),且两组患者术后均未见呼吸抑制情况发生。结论:右美托咪定联合舒芬太尼PCIA用于食管癌患者术后镇痛的效果显著,可有效改善患者的免疫功能,且未增加不良反应的发生。
ABSTRACT: OBJECTIVE: To observe the efficacy of patient controlled intravenous analgesia (PCIA) of dexmedetomidine combined with sufentanil for postoperative analgesia of patients with esophageal cancer, and its effects on immune function of the body. METHODS: Totally 120 cases of esophageal cancer patients who received surgical treatment in our hospital were collected from Jan. 2015 to Jan. 2107, and then divided into control group and observation group according to random number table, with 60 cases in each group. After surgery, all patients received PCIA. Control group was given Sufentanil citrate injection 2 μg/(kg·d)+Tropisetron hydrochloride injection 15 mg+0.9% Sodium chloride injection as PCIA solution 100 mL. Observation group was given Dexmedetomidine hydrochloride injection 0.75 μg/(kg·d)+Sufentanil citrate injection 2 μg/(kg·d)+Tropisetron hydrochloride injection 15 mg+0.9% Sodium chloride injection as PCIA solution 100 mL. The background dose, single dose and locking time PCIA of 2 groups were 2 mL/h, 0.5 mL and 15 min. VAS score of 2 groups were observed after surgery. The plasma levels of IFN-γ and IL-10, CD3+T cell, CD4+T cell, CD8+T cell, CD4+/CD8+, the occurrence of ADR were observed before and after surgery. RESULTS: VAS score of observation group was significantly lower than control group 6, 12, 24, 48 h after surgery (P<0.05), and decreased gradually as time. The plasma level of IFN-γ in 2 groups 6 h after surgery, that of control group 12, 24, 48 h after surgery were significantly higher than before surgery, but the observation group 6, 12, 24, 48 h after surgery was significantly lower than control group. The plasma level of IL-10 in 2 groups 12, 24, 48 h after surgery were significantly higher than before surgery, and the observation group 6, 12, 24, 48 h after surgery was significantly higher than control group (P<0.05). Plasma level of CD3+T cell of control group 12, 24, 48 h after surgery were lower than before surgery, but the observation group was significantly higher than control group 6, 12, 24 h after surgery. Plasma level of CD4+T cell of 2 groups 12, 24 h after surgery were significantly lower than before surgery, but the observation group was significantly higher than control group 6, 12, 24 h after surgery. Plasma level of CD8+T cell of control group 24 h after surgery, those of observation group 12, 24 h after surgery were significantly lower than before surgery; the observation group was significantly lower than control group 12, 24 h after surgery. Plasma level of CD4+/CD8+ of control group 12, 24 h after surgery were significantly lower than before surgery; those of observation group 12, 24 h after surgery were significantly higher than before surgery, and CD4+/CD8+ level 6, 12, 24 h after surgery were also higher than control group (P<0.05). There was no statistical significance in the incidence of ADR between 2 groups (P>0.05). No respiratory depression occurred in neither groups after surgery. CONCLUSIONS: PCIA of dexmedetomidin combined with sufentanil is significantly effective for postoperative analgesia of patients with esophageal cancer, it can improve the immune function of patients without enhancing the occurrence of ADR.
期刊: 2018年第29卷第24期
作者: 高彦东,席俊峰,高静,罗瑞,边步荣,任伟荣
AUTHORS: GAO Yandong,XI Junfeng,GAO Jing,LUO Rui,BIAN Burong,REN Weirong
关键字: 右美托咪定;舒芬太尼;静脉自控镇痛;食管癌;术后;镇痛效果;免疫功能;安全性
KEYWORDS: Dexmedetomidin; Sufentanil; Patient controlled intravenous analgesia; Esophageal cancer; Post-operative; Analgesia effect; Immune function; Safety
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