乳腺癌根治术患者术后不同镇痛方式对细胞免疫功能及炎症介质的影响

发布时间：2018-06-24 17:10

本文选题：地佐辛 + 芬太尼　；参考：《广东医学》2015年04期

【摘要】：目的观察乳腺癌根治术患者围术期应用地佐辛或芬太尼镇痛对术后细胞免疫及炎症介质的影响。方法将24例择期行乳腺癌根治术患者随机分为D组和F组,每组12例。采用气管插管全身麻醉,D组麻醉诱导时静脉注射地佐辛0.2 mg/kg,术毕前20 min静脉注射地佐辛2.5 mg;F组麻醉诱导时静脉注射芬太尼3μg/kg,术毕前20 min静脉注射芬太尼50μg。术后48 h采用地佐辛40 mg(D组)或芬太尼0.8 mg(F组)行静脉自控镇痛(PCIA)。两组患者术后1、4、8、12、24、48 h记录VAS评分,分别于麻醉前(T0)、术毕(T1)、术后1 d(T2)、术后3 d(T3)、术后7 d(T4)采集静脉血,采用流式细胞仪检测外周T淋巴细胞亚群(CD3+、CD4+、CD8+水平以及CD4+/CD8+比值)和NK细胞水平;采用酶联免疫吸附法(ELISA)检测血清IL-2和IL-10浓度。结果术后4、8、12、24 h VAS评分D组低于F组(P0.05),与T0相比,两组T1、T2时点CD3+、CD4+水平以及CD4+/CD8+比值和NK细胞水平明显降低(P0.05);组间比较,D组T1、T2时点CD3+、CD4+水平以及CD4+/CD8+比值和NK细胞水平明显高于F组(P0.05)。与T0比较,F组T1、T2时血清IL-2浓度降低,T2时血清IL-10浓度升高(P0.05),D组T2时血清IL-2浓度降低(P0.05);组间比较,D组T1、T2时血清IL-2浓度明显高于F组(P0.05),D组T2时血清IL-10浓度明显低于F组(P0.05)。结论围术期地佐辛应用乳腺癌根治术患者镇痛可以改善术后细胞免疫功能。
[Abstract]:Objective to observe the effect of perioperative analgesia with dizosin or fentanyl on cellular immunity and inflammatory mediators in patients undergoing radical mastectomy. Methods Twenty-four patients undergoing elective radical mastectomy were randomly divided into group D and group F with 12 cases in each group. In group D, dizosin 0.2 mg / kg was injected intravenously during anesthesia induction by endotracheal intubation, and fentanyl 3 渭 g / kg was injected intravenously in group F 20 min before the end of operation. Fentanyl 50 渭 g / kg was injected intravenously 20 min before the end of the operation. 48 hours after operation, intravenous controlled analgesia (PCIA) was performed with dizosin 40 mg (group D) or fentanyl 0.8 mg (group F). VAS scores were recorded at 1, 4, 8, 12, 24, 48 h postoperatively in both groups. Venous blood was collected before anesthesia (T0), after operation (T1), 1 day (T2), 3 days (T3), 7 days after operation (T4), respectively. Peripheral T lymphocyte subsets (CD4 / CD8, CD4 / CD8 / CD4 / CD8) and NK cells were detected by flow cytometry, and serum IL-2 and IL-10 were detected by enzyme-linked immunosorbent assay (Elisa). Results the VAS score in group D was lower than that in group F at 24 h after operation (P0.05), compared with T0. The levels of CD4, CD4 / CD8 and NK cells in T _ 1 / T _ 2 group were significantly lower than those in T _ 1 / T _ 2 group (P0.05), and the levels of CD _ 3 / CD _ 4, CD _ 4 / CD _ 8 ratio and NK cell in D group at T _ 1 T _ 2 were significantly higher than those in F group (P0.05). Compared with T0, the level of serum IL-2 in T _ 1T _ 2 in F group was lower than that in T _ 2 group (P0.05), and the serum IL-2 concentration in T _ 2 in D group was significantly higher than that in T _ 2 group (P0.05), and the level of IL-10 in T _ 2 in D group was significantly lower than that in F group (P0.05). Conclusion perioperative dizosin analgesia can improve postoperative cellular immune function in patients undergoing radical mastectomy.
【作者单位】：广东省佛山市第二人民医院麻醉科;广东省佛山市第二人民医院外科;中山大学附属第一医院麻醉科;
【基金】：广东省科技计划项目(编号:2012A030400042)
【分类号】：R737.9

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