羟考酮预处理对妇科肿瘤手术中炎症因子、免疫功能及罗库溴铵诱导体动反应的影响

目的:探讨羟考酮预处理对妇科肿瘤手术中炎症因子、免疫功能及罗库溴铵诱导体动反应的影响。方法:将186例择期行妇科肿瘤手术患者随机分为对照组及羟考酮组,各93例。羟考酮组于麻醉前予以盐酸羟考酮5 mg静脉注射,对照组以生理盐水静脉注射,麻醉诱导后予以罗库溴铵0.6 mg/kg静脉注射,观察并记录两组患者苏醒情况及体动反应发生情况,分别于麻醉诱导前(T0)、术后4 h(T1)、术后8 h(T2)、术后24 h(T3)、术后48 h(T4)观察患者,比较两组各时间点炎症因子水平及镇痛、免疫功能情况。结果:两组自主呼吸恢复时间、睁眼时间、拔管时间和睫毛反射时间无明显差异(P均>0.05),羟考酮组患者罗库溴铵诱导体动反应发生较对照组明显减少(P<0.05);两组T0、T2~4时RASS评分及VAS评分无明显统计学差异(P均>0.05),羟考酮组患者T1时RASS评分、VAS评分较对照组明显降低(P均<0.05);两组T0时TNF-α、IL-6、IL-10、CD4^+T淋巴细胞、CD8^+T淋巴细胞和CD4^+/CD8^+T淋巴细胞水平无明显差异(P均>0.05)。与T0时相比,两组TNF-α、IL-6、IL-10水平在T1~4明显上升(P均<0.05),与对照组相比,羟考酮组IL-10升高更显著,TNF-α、IL-6变化幅度较小。与T0时相比,CD4^+T淋巴细胞、CD8^+T淋巴细胞和CD4^+/CD8^+T淋巴细胞水平在T1~3明显下降(P均<0.05),在T4时回升,羟考酮组T1~3的CD4T淋巴细胞、CD8^+T淋巴细胞和CD4^+/CD8^+T淋巴细胞水平变化幅度较对照组小。结论:羟考酮预处理能减少妇科肿瘤手术患者罗库溴铵诱导体动反应,缓解患者术后疼痛,减轻患者全身炎症及免疫反应。

Clinical effects of oxycodone pretreatment in patients receiving gynecologic tumor surgery on inflammatory factors，immune function and rocuronium-induced withdrawal movements

Objective:To study the clinical effects of oxycodone pretreatment in patients receiving gynecologic tumor surgery on inflammatory factors，immune function and rocuronium-induced withdrawal movements.Methods:186 patients receiving gynecologic tumor surgery were divide into control group(93 cases) and oxycodone group(93 cases) by random.Intravenous injection of normal saline was given to control group while oxycodone hydrochloride(5 mg) instead in oxycodone group before anesthesia.Rocuronium(0.6 mg/kg) was given to patients intravenously after anesthesia induction.The awakening of patients and the occurrence of body motion after injection of rocuronium was observed.At preanesthesia induction(T0)，post-operative 4 h(T1)，post-operative 8 h(T2)，post-operative 24 h(T3)，post-operative 48 h(T4)，the serum levels of inflammatory factors and analgesia and immune function were observed and compared between two groups.Results:There was no significant difference in spontaneous breathing recovery time，blink time，extubation time and eyelash reflex time between the two groups(P>0.05).Compared with the control group，rocuronium induced withdrawal movements were significantly decreased in the oxycodone group(P<0.05).There was no significant difference in RASS score and VAS score at T0 and T2~4 between two groups(P>0.05).Compared with the control group，the RASS score and VAS score were significantly decreased at T1 in the oxycodone group(P<0.05).There was no significant difference in the levels of TNF-α，IL-6，IL-10，CD4+T lymphocytes，CD8+T lymphocytes and CD4+/CD8+T lymphocytes in serum at T0 between the two groups(P>0.05).Compared with T0，the levels of TNF-α，IL-6 and IL-10 in two groups increased significantly in T1~4(P<0.05).Compared with the control group，IL-10 increased more significantly in the oxycodone group(T1~4)，while the changes of TNF-α and IL-6 were smaller.Compared with T0，levels of CD4+T lymphocytes，CD8+T lymphocyte and CD4+/CD8+T lymphocytes decreased significantly in T1~3(P<0.05)，and rebounded at T4.Compared with the control group，the changes of levels of CD4+T lymphocytes，CD8+T lymphocyte and CD4+/CD8+T lymphocytes in T1~3were smaller in the oxycodone group.Conclusion:Rocuronium induced withdrawal movements in patients receiving gynecologic tumor surgery is reduced after oxycodone pretreatment.Postoperative pain，systemic inflammation and immune response are decreased after oxycodone pretreatment.