多模式镇痛对肾移植后免疫功能的影响  

Effect of multimodal analgesia on immunological function after renal transplantation

作　　者：李洪[1] 罗远国[1] 张旭[1] 曾军[1] 王东[1] 袁振宇[1] 袁峰[2] 眭维国[2] 陈洁晶[2] 

机构地区：[1]解放军第181医院麻醉科,广西壮族自治区桂林市541002 [2]解放军第181医院全军肾移植与透析治疗中心,广西壮族自治区桂林市541002

出　　处：《中国组织工程研究》2014年第36期5874-5878,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:多模式镇痛模式应用于肾移植受者可有效减轻疼痛,并有利于移植肾功能恢复。目的:观察地佐辛多模式镇痛对肾移植后患者免疫功能的影响,并探讨合适的移植后镇痛药物及方式。方法:40例肾移植患者随机分为两组,均行硬膜外阻滞复合全身麻醉。对照组间断肌注镇痛药物,地佐辛多模式镇痛组给予地佐辛超前镇痛+术后硬膜外患者自控镇痛。记录麻醉前,移植后12,24,48 h的心率、动脉平均血压、血氧饱和度;抽取静脉血检测T淋巴细胞亚群含量和白细胞介素2、白细胞介素6和白细胞介素10水平。结果与结论:与麻醉前比较,对照组移植后CD4+、CD8+、CD4+/CD8+、白细胞介素2和白细胞介素6水平均明显下降(P<0.05),白细胞介素10水平明显升高(P<0.05)。地佐辛多模式镇痛组CD4+、白细胞介素2、白细胞介素6水平在移植后12 h低于麻醉前(P<0.05),移植后24 h则恢复至麻醉前水平。CD8+、CD4+/CD8+与移植前比较变化不明显。白细胞介素10水平在移植后48 h明显高于移植前,但低于对照组(P<0.05)。结果可见地佐辛多模式镇痛对肾移植后免疫功能有一定的保护作用,对患者移植肾肾功能短期转归和移植物的长期存活起积极作用。BACKGROUND：Multimodal analgesia provides sufficient analgesia in renal recipients and appears to be associated with the recovery of renal function after transplantation. OBJECTIVE：To investigate the effect of multimodal analgesia with dezocine on postoperative immunity after renal transplantation, and discuss the appropriate analgesic drugs and methods for patients with renal transplantation. METHODS：Forty patients undergoing renal transplantation were randomly divided into two groups. They al received general anesthesia combined with epidural blockage. Control group received intramuscular injection of analgesic drugs when needed, while dezocine group received multimodal analgesia：preemptive anaIgesia with dezocine＋patient-control ed epidural analgesia. The heart rate, mean arterial pressure, and saturation of blood oxygen were detected before anesthesia, 12, 24, 48 hours after transplantation. T lymphocyte subsets, interleukin-2, interleukin-6 and interleukin-10 levels in venous blood were measured before anesthesia, 12, 24, 48 hours after transplantation. RESULTS AND CONCLUSION：Compared with before anesthesia, the CD4＋, CD8＋cellsubset counts, CD4＋/CD8＋ratio, the levels of interleukin-2 and interleukin-6 were decreased significantly （P〈0.05）, and the levels of interleukin were significantly increased after transplantation in the control group （P〈0.05）. The postoperative CD4＋cellsubset counts, the levels of interleukin-2 and interleukin-6 were significantly lower at 12 hours after transplantation than that before anesthesia （P〈0.05）, then recovered to normal levels at 24 hours in dezocine group. The postoperative CD8＋cellsubset counts, CD8＋and CD4＋/CD8＋ratio were not changed before and after transplantation in the dezocine group. The levels of interleukin-10 in the dezocine group were significantly increased at 48 hours after transplantation compared with before anesthesia （P〈0.05）, which was stil lower than that in control group （P〈0.05）. Multimodal ana

关 键 词：移植 组织构建 肾移植 地佐辛 多模式镇痛 免疫 细胞因子 

分 类 号：R318[医药卫生—生物医学工程]