| 右美托咪定复合舒芬太尼对肺癌患者术后镇痛效果及细胞免疫功能的影响 #br# |
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| 引用本文： | 李国利,高晓茹,王暐,张悦,曹亮,李福龙,滕金亮 △. 右美托咪定复合舒芬太尼对肺癌患者术后镇痛效果及细胞免疫功能的影响 #br#[J]. 天津医药, 2020, 48(5): 396-401. DOI: 10.11958/20192855 |
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| 作者姓名： | 李国利 高晓茹 王暐 张悦 曹亮 李福龙 滕金亮 △ |
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| 作者单位： | 1河北北方学院附属第一医院麻醉科（邮编075000）；2张家口市第四医院麻醉科 |
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| 基金项目： | 河北省科技厅重点研发计划项目（19277778D）；张家口市2016年度科学技术研究与发展计划（1621071D） |
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| 摘 要： | 摘要：目的 探究右美托咪定复合舒芬太尼麻醉对肺癌患者根治手术后的镇痛效果和机体免疫功能的影响。方法 选择我院 2017年 7月—2019年 7月拟行肺切除术的 120例肺癌患者，根据麻醉方法不同分为单一组和复合组，每组60例。术前麻醉诱导行肺切除术，术后单一组患者静脉输注舒芬太尼进行患者静脉自控镇痛（PCIA），复合组患者静脉输注右美托咪定复合舒芬太尼进行 PCIA。术后 1、6、12、24、48 h对 2组患者行疼痛视觉模拟评分（VAS）和舒适度评分（BCS）以评估镇痛效果；另在术前、术后 12、24、48 h、1周测定 2组患者外周血中自然杀伤（NK）细胞、CD3+T细胞、CD4+T细胞、CD8+T细胞、CD4+/CD8+水平以及干扰素-γ（IFN-γ）和白细胞介素-10（IL-10）表达水平。结果 （1）与单一组相比，复合组患者术后 1、6、12、24、48 h的 VAS评分下降，BCS评分升高（P＜0.01）。（2）复合组患者术后12、24、48 h和1周时NK细胞、CD3+ T细胞、CD4+ T细胞及CD4+/CD8+均高于单一组，术后12、24、48 h时CD8+ T细胞的水平明显低于单一组（P＜0.05）；术后 12、24、48 h和 1周时 IFN-γ含量显著低于单一组，而同期 IL-10水平均显著高于单一组（P＜0.05或P＜0.01）。2组患者术后各项并发症的发生率差异无统计学意义（P＞0.05）。结论 右美托咪定复合舒芬太尼PCIA对肺癌患者根治手术后的镇痛效果更佳，患者术后舒适度和机体免疫功能明显提高。
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| 收稿时间： | 2019-09-17 |
| 修稿时间： | 2020-03-03 |
Effects of dexmedetomidine combined with anesthesia on postoperative analgesia and cellular immune function in lung cancer patients #br# |
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| LI Guo-li,GAO Xiao-ru,WANG Wei,ZHANG Yue,CAO Liang,LI Fu-long,TENG Jin-liang△. Effects of dexmedetomidine combined with anesthesia on postoperative analgesia and cellular immune function in lung cancer patients #br#[J]. Tianjin Medical Journal, 2020, 48(5): 396-401. DOI: 10.11958/20192855 |
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| Authors: | LI Guo-li GAO Xiao-ru WANG Wei ZHANG Yue CAO Liang LI Fu-long TENG Jin-liang△ |
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| Abstract: | Abstract：Objective To explore the effects of dexmedetomidine combined with sufentanil anesthesia on the analgesiceffect and immune function of patients with lung cancer resection. Methods A total of 120 patients with lung cancer whowere admitted to our hospital from July 2017 to July 2019 were randomly divided into single group and composite group, with60 patients in each group. After surgical resection, the patient-controlled analgesia (PCIA) was performed by intravenousinfusion of sufentanil alone in the single anesthesia group and sufentanil combined with dexmedetomidine in the compositeanesthesia group. Visual analogue pain score (VAS) and comfort score (BCS) were performed at 1, 6, 12, 24 and 48 h afterthe surgery to evaluate the analgesic effect in the two groups. In addition, the proportion of immune cells and the expressionlevels of immune factors in the peripheral blood were measured before and at 12, 24, 48 h, 1 week and 2 weeks after surgeryin the two groups. Results (1) VAS and BCS scores were significantly lower in the composite group than those in the singlegroup (P＜0.05). (2) Compared with the same period in the single group, the proportions of NK cells, CD3+ T cells and CD4+/CD8+ were significantly increased in the composite group at 12, 24 and 48 h after surgery (P＜0.05). The CD8+ cells weresignificantly lower at 12, 24 and 48 h after surgery in the composite group (P＜0.05). IFN-γ contents were significantlylower at 12, 24 h, 48 h and 1 week after surgery in the composite group than those of the single group (P＜0.05), while IL-10levels were significantly higher than those of the single group (P＜0.05 or P＜0.01). There was no significant difference inthe incidence of postoperative complications between the two groups (P＞0.05). Conclusion Dexmedetomidine combined with sufentanil PCIA has better analgesic effect and higher postoperative comfort in patients after radical operation. Mostimportantly, the compound anesthesia can improve the immune function. |
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