地佐辛与芬太尼术后静脉自控镇痛对老年胃肠道肿瘤患者免疫功能的影响

目的研究地佐辛与芬太尼术后静脉自控镇痛（PCIA）对胃肠道肿瘤患者免疫功能的影响。方法将80例肿瘤手术患者按数字表法分为地佐辛组与芬太尼组，每组各40例患者。芬太尼组采用芬太尼0．8mg＋生理盐水稀释到100ml镇痛方案；地佐辛组采用镇痛泵使用前先静脉注射5mg负荷量的地佐辛，然后采用地佐辛20mg＋生理盐水稀释到100ml的镇痛方案．手术前、手术后24小时、48小时、72小时测定患者外周血T淋巴细胞亚群（CD3^＋、CD4＋,CD4＋／CD8＋）。结果两组患者的一般资料无统计学差异．两组术后24小时CD3^＋、CD4＋,CD4＋／CD8^＋均较手术前降低，差异有显著性（P〈0．05），两组术后24小时CD3＋、CD4^＋相比地佐辛组更高，差异有显著性（P〈0．05），48小时后两组均升高，而芬太尼组仍低于手术前水平，地佐辛组则恢复接近正常水平，两组相比地佐辛组高于芬太尼组，差异有显著性（P〈0．05），72小时后两组均恢复至术前水平。结论地佐辛术后静脉自控镇痛对患者免疫功能抑制较轻，术后患者免疫功能恢复较快，对机体的免疫功能有较好的保护作用，值得老年胃肠道肿瘤患者临床广泛推广应用。

Effects of PCIA with dezocine and Fentanyl on the immune function of elderly patients with gastrointestinal cancer

Objective To investigate the effect of patient controlled intravenous analgesia （PCIA） with de- zocine and fentanyl on the distribution of T-lymphocytes in elderly patients with gastrointestinal cancer. Meth- ods 80 patients with tumor undergoing radical operation were randomly divided into dezocine group and fen- tanyl group, 40 cases in each group. All patients used PCIA. The analgesic regimen of fentanyl group was 0.8 mg fentanyl＋saline diluted to 100 ml, the analgesic regimen of dezocine group was dezocine 20 mg＋saline diluted to 100 ml after intravenous injection of 5 mg load of dezocine. Peripheral blood samples were obtained before opera- tion, 24, 48, 72 hours after operation. T-lymphocyte subsets were measured, and used VAS score to record pa- tients＇ satisfaction. Results The amount of CD3^＋,CD4^＋, CD4^＋/CD8＋ lymphocytes decreased 24 hours after opera- tion in two groups （P〈0.05）, The amount of CD3^＋, CD4＋, CD4^＋/CD8^＋ lymphocytes in dezocine groups were nearly to baseline in 48 hours postoperatively, and significantly higher than those of fentanyl group. The whole T-lym- phocytes recovered in 72 hours postoperatively in two groups. Conclusion Dezocine has less impact on immune function in elderly patients with gastrointestinal cancer.