酮咯酸氨丁三醇预防性镇痛对乳腺癌改良根治术患者镇痛效果及免疫功能的影响

目的探讨酮咯酸氨丁三醇预防性镇痛应用于乳腺癌改良根治术患者的镇痛效果及对免疫功能的影响。方法选择择期乳腺癌改良根治术患者70例,年龄36~65岁,体重45~75kg,ASAⅠ或Ⅱ级,根据患者是否接受镇痛分为预防性镇痛组(A组)和对照组(C组),每组35例。两组患者均采用气管插管全麻,预防性镇痛组在麻醉诱导前30min给予酮铬酸氨丁三醇60mg入壶静滴,对照组同时给予等量生理盐水。记录两组患者麻醉诱导前(T_0)、术后30min(T_1)、1h(T_2)、4h(T_3)和24h(T_4)时疼痛VAS评分。在T_0、T_4时测量患者血浆T_淋巴细胞亚群(CD3~+、CD4~+、CD8~+)及白细胞介素(IL)~(-1)β、IL-6、IL~(-1)0水平。结果 T_1~T_4时C组患者VAS评分明显高于T_0时和A组(P0.05);T_4时C组T_淋巴细胞亚群CD3~+、CD4~+及CD8~+明显低于T_0时和A组(P0.05),两组CD4~+/CD8~+组间组内差异无统计学意义;T_4时C组IL~(-1)β和IL-6水平明显高于T_0时和A组,T_4时A组IL~(-1)0水平明显高于T_0时和C组(P0.05)。结论酮咯酸氨丁三醇预防性镇痛应用于乳腺癌改良根治术患者能取得较好的镇痛效果,同时能够保护患者免疫功能,抑制炎性反应,减轻手术及麻醉对患者免疫功能的抑制作用。

Influence on analgesic effect and immune function in patients undergoing modified radical mastectomy with ketorolac tromethamine in preventive analgesia

Objective To investigate the analgesic effect and the influence on immune function in patients undergoing modified radical mastectomy with ketorolac tromethamine in preventive analge-sia.Methods Seventy cases of breast cancer,aged 36-65 years,weight 45-75 kg,ASA Ⅰ or Ⅱ. They were divided into preventive analgesia group (group A)and control group (group C)according to the patient??s subjective desire,35 cases in each group.Patients were treated with general anesthe-sia,administrated ketorolac tromethamine 60mg intravenous drip into the pot at 30 min before induc-tion of anesthesia in preventive analgesia group,while the same amount of 0.9% sodium chloride was given in control group.Pain score was measured before induction of anesthesia (T0 ),30 min after op-eration (T1 ),1 h after operation (T2 ),4 h after operation (T3 )and 24 h after operation (T4 ).Plas-ma T cell subsets (CD3 + ,CD4 + ,CD8 + )and interleukin (IL-1β,IL-6,IL-10)levels were deter-mined before induction of anesthesia (T0 )and 24 h after operation (T4 )respectively.Results The patients??s pain scores in preventive analgesia group were lower than that in the control group at each time point (P <0.05).Compared with the preoperation,the patients??s pain scores were not statistically different in preventive analgesia group,while the control group were significantly increased (P <0.05).Compared with control group,CD3 + ,CD4+ ,CD8 + and anti-inflammatory cytokine was obviously increased,proin-flammatory cytokines IL-1βand IL-6 significantly decreased in preventive analgesia group.CD3 + ,CD4+ , CD8 + ,IL-1βand IL-6 were not statistically significant compared with T0 in preventive analgesia group, while IL-10 significantly increased;CD3 + ,CD4+ ,CD8 + were significantly reduced compared with T0 in control group,while IL-1βand IL-6 increased significantly at T4 (P <0.05).Conclusion Better analgesic effect and enhanced the immune function were achieved in patients undergoing modified radical mastectomy with ketorolac tromethamine in preventive analgesia.