地佐辛术后镇痛对妇科恶性肿瘤患者血浆儿茶酚胺及免疫功能的影响

发布时间：2018-04-28 18:27

本文选题：地佐辛 + 术后镇痛　；参考：《临床麻醉学杂志》2015年09期

【摘要】：目的观察地佐辛用于妇科恶性肿瘤手术患者术后镇痛的效果及对血浆儿茶酚胺和免疫功能的影响。方法择期行妇科恶性肿瘤手术患者60例,随机均分为地佐辛组(D组)和芬太尼组(F组),采用静脉复合全麻,术毕使用患者静脉自控镇痛(PCIA),D组PCIA配方为地佐辛0.8mg/kg加托烷司琼6mg加生理盐水配至100ml,F组PCIA配方为芬太尼0.01mg/kg加托烷司琼6mg加生理盐水配至100ml。记录患者术前(T0)、术毕(T1)、术后2h(T2)、6h(T3)、24h(T4)和48h(T5)的SBP、DBP、HR、SpO2及T1~T5时静息时和活动时VAS疼痛评分、Ramsay镇静评分及恶心、呕吐、低血压、呼吸抑制等不良反应。于T0、T1、T4、T5时抽取静脉血4 ml,其中2 ml采用ELISA法测定血浆肾上腺素(E)、去甲肾上腺素(NE)、多巴胺(DOP)水平,剩余2ml采用流式细胞仪测定CD3+、CD4+、CD8+、CD4+/CD8+及NK细胞活性。结果两组患者SBP、DBP、HR、SpO2、Ramsay镇静评分差异均无统计学意义。T2~T4时D组安静时和活动时VAS评分明显低于F组(P0.05)。与T0时比较,T1时两组E、NE、DOP水平明显降低(P0.05或P0.01)。与T1时比较,T4、T5时两组E、NE、DOP水平明显升高(P0.01)。与F组比较,T4、T5时D组NE水平明显降低(P0.05)。与T0时比较,T1、T4时D组CD3+、CD4+、CD4+/CD8+、NK细胞活性明显降低(P0.01),T1时CD8+活性明显升高(P0.01),T1时F组CD3+、CD4+、CD4+/CD8+、NK细胞活性和T4时CD3+、NK细胞活性,T5时NK细胞活性明显降低(P0.05或P0.01)。与F组比较,T5时D组CD3+、CD4+、NK细胞活性明显升高(P0.05或P0.01)。两组患者术后48h不良反应发生情况差异无统计学意义。结论地佐辛用于妇科恶性肿瘤术后镇痛安全有效,与芬太尼比较镇痛效果好,术后应激反应较轻、细胞免疫功能恢复更快。
[Abstract]:Objective to observe the effect of dizosin on postoperative analgesia and plasma catecholamine and immune function in patients with gynecological malignant tumor. Methods Sixty patients with gynecological malignant tumor were randomly divided into two groups: group D (group D) and group F (group F). The PCIA formula of group D was dizosin 0.8mg/kg plus tropisetron 6mg plus normal saline after operation, and that of group F was fentanyl 0.01mg/kg plus troponisetron 6mg plus normal saline to 100ml. The adverse reactions such as preoperative T0, T1, 6hT3, 24 hT4 and 48h T5) were recorded. The scores of VAS pain at rest and during T1~T5, including sedation score, nausea, vomiting, hypotension, respiratory depression and so on, were also recorded. Venous blood was collected at T0 T _ 1 T _ 4 T _ 4 T _ 5, 2 ml of which was measured by ELISA method for plasma epinephrine, norepinephrine (NE), dopamine dop (DOP), and the remaining 2ml was measured by flow cytometry (FCM) to determine the CD4 / CD8 and NK cell activity of CD3. Results there was no significant difference in the sedation score between the two groups. The VAS score of group D was significantly lower than that of group F (P 0.05) at rest and activity at T _ 2 / T _ 4. Compared with T0, the DOP level of EMA in both groups was significantly lower than that at T0 (P 0.05 or P 0.01). Compared with T1, the DOP level of Eneo in T4 + T5 group was significantly higher than that in T4 + T5 group. Compared with group F, NE level in group D was significantly lower than that in group F at T4 and T5. Compared with that at T0, the activity of CD4 / CD8 / CD8 NK cells in group D was significantly lower than that in group D at T0 / T4. The activity of CD8 was significantly increased in group F at P0.01T 1 and that in CD3 CD4 / CD8 + T 5 in group T 4 and in group T 5. The activity of NK cells in T 5 or T 4 was significantly decreased by P0.05 or P0.01T 1, compared with that in group D at T 1 and T 4. The activity of CD 4 / CD 8 + NK cells in T 1 group was significantly lower than that in T 1 group (P 0. 01). Compared with group F, the NK cell activity of CD3 in group D was significantly higher than that in group F (P 0.05 or P 0.01). There was no significant difference between the two groups in the incidence of adverse reactions 48 hours after operation. Conclusion Dizosin is safe and effective in postoperative analgesia for gynecological malignant tumors. Compared with fentanyl, it has better analgesic effect, less stress response and faster recovery of cellular immune function.
【作者单位】：江苏省肿瘤医院麻醉科;
【基金】：江苏省肿瘤医院科研基金专科建设项目(ZS201204)
【分类号】：R614;R737.3

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