地佐辛静脉自控镇痛对肺叶切除术后免疫功能的影响

目的:观察地佐辛静脉自控镇痛对肺叶切除术后免疫功能的影响.方法:选取60例拟行开胸肺叶切除术的患者随机分为对照组和DEZ组,每组30例.DEZ组术后PCA泵注0.5 mg·ml^-1地佐辛,对照组术后PCA泵注0.9%氯化钠.采集患者麻醉诱导前(T0)、术后4 h(T1)、术后24 h(T2)和术后48 h(T3)血标本,测定血清CRP、TNF-α、IL-2、IL-6和IL-10水平,以及外周血淋巴细胞(L)计数及淋巴细胞中CD4⁺T淋巴细胞、CD8⁺T淋巴细胞、自然杀伤细胞(NK)比例的变化.于T1、T2和T3时点随访患者,记录患者视觉模拟评分(VAS)和数字镇静评分(NSS).结果:肺叶切除术后患者血清CRP、TNF-α、IL-6和IL-10的水平较术前明显升高(P <0.05),IL-2较术前降低(P <0.05);术后外周血淋巴细胞计数及CD4⁺T淋巴细胞比例和NK细胞比例较术前降低(P <0.05);地佐辛静脉自控镇痛能明显降低术后血清CRP、IL-6,升高IL-2及CD4⁺T淋巴细胞比例(P <0.05);地佐辛组患者术后24 h的VAS评分低于对照组(P <0.05).结论:地佐辛静脉镇痛具有免疫调节作用,可改善肺叶切除术后的免疫抑制,并减轻炎症反应.

Effects of patient controlled analgesia with intravenous dezocine on immune functions after pulmonary lobectomy

OBJECTIVE To investigate effects of patient controlled analgesia (PCA) with intravenous dezocine on immune function in patients after pulmonary lobectomy. METHODS A total of 60 patients scheduled for pulmonary lobectomy were randomly enrolled in this study. Patients were assigned to control group (PCA with 0.9% sodium chloride, n=30) and DEZ group (PCA with 0.5 mg·ml^-1 dezocine,n=30). Serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2), interleukin-6 (IL-6), and interleukin-10 (IL-10) were determined before induction of anesthesia (T0), 4 h after operation (T1), 24 h after operation (T2) and 48h after operation (T3). Blood samples were also analyzed for total lymphocyte count, and percentages of CD4⁺ T cells, CD8⁺T cells and natural killer (NK) T cells. Visual analogue scale (VAS) and numeric sedation scale (NSS) were recorded at T1, T2 and T3. RESULTS The serum CRP, TNF-α, IL-6 and IL-10 increased remarkably after operation (P <0.05), while IL-2 was decreased (P <0.05). Total lymphocyte count and percentages of CD4⁺T cells and NK cells decreased after operation (P <0.05). The serum CRP and IL-6 were significantly lower in DEZ group after operation (P <0.05), while serum IL-2 and percentage of CD4⁺T cells were higher in DEZ group (P <0.05). VAS at 24 h after operation was lower in DEZ group (P <0.05). CONCLUSION PCA with dezocine has notable immunoregulating effects, which can alleviate immunosupression and inflammation after pulmonary lobectomy.