右美托咪啶复合吗啡静脉自控镇痛对食管癌术后外周血T细胞亚群及NK细胞的影响

发布时间：2018-03-15 21:33

  本文选题：右美托咪啶　切入点：吗啡　出处：《福建医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的观察右美托咪啶联合吗啡静脉自控镇痛对食管癌患者根治术后外周血T淋巴细胞亚群（CD3+、CD4+、CD8+、CD4+/CD8+）以及自然杀伤细胞（NK细胞）的影响。 方法选择食管癌根治术患者60例，ASAⅠ～Ⅱ级，年龄40～60岁，采用随机数字表法，随机分为吗啡镇痛组（M组，n=30）和右美托咪啶联合吗啡镇痛组（DM组，n=30）。于手术结束即刻行病人自控静脉镇痛，M组采用吗啡0.02mg/kg/h，DM组采用吗啡0.02mg/kg/h+右美托咪啶1ug/kg/d,均用生理盐水稀释至150ml。术后24h、48h、72h采用视觉模拟评分法(VAS评分）评价镇痛效果；记录镇痛期间内的吗啡用量、PCA总次数和有效按压次数；并记录在此期间恶心呕吐、瘙痒、心动过缓、低血压、镇静过度、呼吸抑制等不良反应的发生率。于麻醉诱导前、拔管即刻、术后24h、48h、72h测定CD3+、CD4+、CD8+、CD4+/CD8+及NK细胞的表达水平。 结果两组患者术后VAS评分比较差异无统计学意义(P0.05)；镇痛期间两组患者均未发生心动过缓、低血压、过度镇静和呼吸抑制等不良反应。与M组比较，DM组术后24h、48h、72h内吗啡用量、PCA总按压次数和有效按压次数降低，术后恶心呕吐及瘙痒的发生率也降低(P0.05)。与各自相应的麻醉前基础值相比，两组患者的CD3+、CD4+、CD4+/CD8+值于拔管即刻开始下降，术后24h最低，术后48，72h内逐渐恢复，差异有统计学意义(P 0.05)；两组患者的NK细胞在拔管即刻、术后24h、48h、72h也比麻醉前降低(P 0.05)；而各时间点组内或组间的CD8+值相比较，差异无统计学意义(P0.05)。与M组相比，DM组在术后24h、48h、72h内CD3+、CD4+、CD4+/CD8+及NK值下降幅度较小，，差异有统计学意义(P 0.05)。 结论与M组静脉镇痛相比，食管癌根治术后患者采用DM组，在相同的镇痛效果基础上可减少吗啡用量，降低不良反应发生率。DM组能更有效地食道癌术后患者T淋巴细胞亚群（CD3+、CD4+、CD4+/CD8+）和NK细胞的抑制,对机体细胞免疫功能有一定的保护作用,更有利于食管癌患者术后细胞免疫功能的恢复。
[Abstract]:Objective To observe the effect of dexmedetomidine combined with morphine intravenous analgesia on peripheral blood T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) and natural killer cells (NK cells) in patients with esophageal cancer after radical operation.
Methods 60 cases of patients with esophageal cancer radical surgery, ASA I-II, age 40~60 years, were randomly divided into morphine analgesia group (group M, n=30) and dexmedetomidine combined with morphine analgesia group (group DM, n=30). At the end of the patient-controlled intravenous analgesia for surgery 0.02mg/kg/h, M group with DM group with morphine, morphine 0.02mg/kg/h+ dexmedetomidine 1ug/kg/d, were diluted with saline to 150ml. after 24h, 48h, 72h by using visual analogue scale (VAS score) to evaluate the analgesic effect of morphine analgesia; recorded during dosage, times of PCA and effective pressing numbers; and on this record during the period of nausea and vomiting, pruritus, bradycardia, hypotension, excessive sedation, the incidence of respiratory depression and other adverse reactions. Before induction of anesthesia, extubation, postoperative 24h, 48h, 72h, CD4+, CD8+, CD3+ were measured, the expression level of CD4+/CD8+ and NK cells.
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