舒芬太尼靶控镇痛对腹腔镜术后患者免疫功能和相关介质影响的临床研究

发布时间：2018-04-13 14:09

本文选题：舒芬太尼 + 靶控镇痛　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:观察舒芬太尼靶控镇痛对腹腔镜术后患者的免疫功能以及相关介质的影响,为靶控镇痛应用于临床提供参考。方法:30例罹患下腹部恶性肿瘤疾病患者,择期在腹腔镜下行根治术,美国麻醉医师协会分级ASA I~II级,年龄45~65岁,随机分为2组,使用舒芬太尼术后镇痛,A组(静脉靶控镇痛组)15例:启始血浆靶浓度0.1ng/ml,Prince-Henry评分3分时上调靶浓度,每一次上调0.01ng/ml,锁定15min。B组(传统静脉镇痛组)15例:背景剂量3μg/h,Prince-Henry评分3分时PCA予3μg/次,锁定15min。异丙酚和舒芬太尼术中持续静脉靶控输注,气管导管拔除后于Prince-Henry评分3分,Ramsay镇静评分2分时上术后镇痛泵,在镇痛前(T0)及上镇痛泵时(T1)、上镇痛泵后1h(T2)、2h(T3)、4h(T4)、8h(T5)、和16h(T6)记录T1-T6时点Prince-Henry镇痛评分、Ramsay镇静评分、生命体征及术中、术后舒芬太尼总用药量和不良反应发生情况;两组患者均在麻醉诱导前、T0、T4、T6各时点采血,ELISA检测血浆P物质、β内啡肽的浓度,并于麻醉诱导前、T0、T6时点测定血中CD4+、CD8+、CD4+/CD8+T淋巴细胞亚群水平。结果:(1)两组患者各时点DBP、SBP、HR、RR、Sp O2比较无明显差异(P0.05)。(2)在T2、T5、T6时点,B组Prince-Henry评分显著高于A组(P0.05)。(3)术后镇痛16h舒芬太尼的用药量A组高于B组(P0.05)。(4)在T6时点,A组患者P物质浓度低于B组,差异具有统计学意义(P0.05);与麻醉前比较,A、B组P物质浓度在T0、T4时点上升(P0.05)。(5)术后A、B组间的各时点β内啡肽浓度比较均无统计学差异(P0.05),与麻醉前比较,A、B组β内啡肽浓度在T0、T4、T6时点升高(P0.05)。(6)A、B组间患者的CD4+、CD8+、CD4+/CD8+淋巴细胞亚群水平比较无统计学差异(P0.05);与麻醉前相比,两组患者CD4+淋巴细胞亚群在T0、T6时点下降(P0.05)。结论:腹腔镜下腹部恶性肿瘤根治术患者术后使用舒芬太尼靶控镇痛,患者血浆中P物质浓度降低,β内啡肽的含量升高不明显,可减轻术后应激反应;使术后早期患者CD4+淋巴细胞轻度减少,对CD8+、CD4+/CD8+淋巴细胞亚群影响不大;且在不增加副作用的情况下具备更完善的镇痛。
[Abstract]:Objective: to observe the effect of sufentanil target controlled analgesia on immune function and related mediums in patients undergoing laparoscopic surgery, and to provide reference for clinical application of target controlled analgesia.Methods Thirty patients with malignant tumors of lower abdomen were randomly divided into two groups. The patients underwent laparoscopic radical mastectomy. The American Society of Anesthesiologists graded ASA I~II, aged 45 to 65 years, and were randomly divided into two groups.Sufentanil was used for postoperative analgesia in group A (15 cases of intravenous target controlled analgesia group: initial plasma target concentration was 0.1 ng / ml) and the target concentration was up-regulated at 3 min after injection of sufentanil.Each time 0.01 ng / ml was upregulated, and the 15min.B group was locked (15 cases in the traditional intravenous analgesia group: PCA was given 3 渭 g / time at 3 渭 g / h Princeton Henry score at the background dose of 3 渭 g / L and locked for 15 min).Propofol and sufentanil were continuously injected intraoperatively with target controlled infusion, and the postoperative analgesia pump was put on at the time of Prince-Henry score of 3 and Ramsay sedation score of 2 points after tracheal catheter extubation.Plasma substance P and 尾 endorphin levels were detected by Elisa at each time point before anesthesia induction, and the levels of CD4 / CD8 T lymphocyte subsets of CD4 / CD8 + T _ 4 / CD _ 8 were measured at T _ 0 / T _ 6 before anesthesia induction.There was no significant difference in the levels of CD4 / CD8 lymphocyte subsets between CD4 / CD8 and CD _ 4 / CD _ 8 groups in patients with T0 / T _ 4 / T _ 6, compared with those before anesthesia, compared with before anesthesia, there was no significant difference in the level of CD4 / CD8 lymphocyte subsets between the two groups.The CD4 lymphocyte subsets in both groups decreased at T 0 T 6 (P 0 05).Conclusion: sufentanil was used in patients undergoing laparoscopic radical operation for abdominal malignant tumor. The plasma concentration of substance P was decreased and the content of 尾 -endorphin was not significantly increased, which could alleviate the stress response after operation.At the early stage of operation, CD4 lymphocytes were slightly decreased, but the CD4 / CD8 subsets of CD8 were not significantly affected, and the analgesia was improved without increasing side effects.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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