地佐辛复合舒芬太尼术后自控静脉镇痛对老年甲状腺癌患者细胞免疫功能的影响  

Influence of PCIA of dezocine combined with sufentanil on cellular immune function in elderly patients after radical resection of thyroid cancer

作　　者：刘泽文[1] 刘会长[1] 严国胜[1] 

机构地区：[1]武汉大学医学院鄂州市中心医院麻醉科,湖北鄂州436000

出　　处：《实用临床医药杂志》2014年第19期70-72,80,共4页Journal of Clinical Medicine in Practice

摘　　要：目的观察地佐辛联合舒芬太尼术后静脉自控镇痛（PCIA）对老年甲状腺癌患者细胞免疫功能的影响。方法选择60例甲状腺癌根治术的老年患者,随机分为地佐辛复合舒芬太尼组（SD组）和舒芬太尼组（S组）,每组30例。所有患者均行全身麻醉,术后均采用静脉自控镇痛（PCIA）。SD组给予地佐辛0.3mg/kg＋舒芬太尼1.0μg/kg＋昂丹司琼8mg＋生理盐水,总量100mL;S组给予舒芬太尼2.0μg/kg＋昂丹司琼8mg＋生理盐水,总量100mL。分别于麻醉前（T0）,术后12h（T1）、24h（T2）、48h（T3）检测C-反应蛋白（CRP）浓度,用流式细胞仪测定T淋巴细胞亚群（CD3^＋、CD4^＋、CD8^＋、CD4^＋/CD8^＋、CD28＋）和NK细胞水平。结果与T0相比,2组患者CRP在T1、T2、T3点均有明显升高（P〈0.01）,与S组相比,SD组患者CRP在T1、T2、T3时间点均低于D组（P〈0.05）;与T0相比,S组CD3^＋、CD4^＋、CD4^＋/CD8^＋、CD28＋和NK细胞在T1、T2、T3各时点降低（P〈0.05）,DS组CD3^＋、CD4^＋、CD4^＋/CD8^＋、CD28＋和NK细胞在T1、T2点降低（P〈0.05）,在T3点已经恢复到T0水平。与S组相比,DS组患者CD3^＋、CD4^＋、CD4^＋/CD8^＋、CD28＋和NK细胞在术后T1-T3各时点高于S组（P〈0.05）;2组CD8^＋水平在各时点无明显差异。结论地佐辛联合舒芬太尼术后自控静脉镇痛可以有效减轻患者术后细胞免疫功能的抑制,更有利于老年甲状腺癌患者术后免疫功能的恢复,值得在临床上推广使用。Objective To explore the effect of patient-controlled intravenous analgesia（PCIA）of dezocine combined with sufentanil on cellular immune function in elderly patients after radical resection of thyroid cancer.Methods 60 elderly patients with radical operation for thyroid cancer were randomly divided into dezocine combined with sufentanil group（Group DS,n=30）and sufentanil group（Group S,n=30）.All the patients were given general anesthesia,and the PCIA formula for group S was 2.0μg/kg of sufentanil＋ 8mg of ondansetron in 100 mL of diluted sodium chloride,the PCIA formula for group SD was 0.3mg/kg of dezoncine＋1.0μg/kg of sufentanil＋8mg of ondansetron in 100 mL of diluted sodium chloride.The contents of C-reactive protein（CRP）,T-lymphocyte subsets and NK cell activities of peripheral venous blood in the two groups were observed before anesthesia（T0）,12hours（T2）,24hours（T3）and 48hours（T4）after operation.Results The postoperative CRP in the two groups at all times were significantly higher than those in T0（P〈0.01）.Compared with group S,CRP of group DS was higher than group S from T1 to T3（P〈0.05）.Compared with T0,CD3^＋,CD4^＋,CD4^＋/CD8^＋,CD28＋and NK cells in group S decreased（P〈0.05）.In group DS,CD3^＋,CD4^＋,CD4^＋/CD8^＋,CD28＋and NK cells decreased at T1,T2 point（P〈0.05）,and returned to the baselines at T3 point.Compared with group S,CD3^＋,CD4^＋,CD4^＋/CD8^＋,CD28＋ and NK cells of group DS were higher than group S from T1 to T3point（P〈0.05）.There were no significant differences of CD8^＋ between the two groups.Conclusion PCIA of dezocine combined with sufentanil in treatment of cellular immune function in elderly patients after radical resection of thyroid cancer can effectively reduce the immunosuppressive effects and promote postoperative recovery of patients,so it is worthy of application in clinic.

关 键 词：地佐辛 舒芬太尼 术后静脉自控镇痛 老年甲状腺癌患者 细胞免疫功能 

分 类 号：R736.1[医药卫生—肿瘤]