地佐辛静脉自控镇痛对肺叶切除术后免疫功能的影响  

Effects of patient controlled analgesia with intravenous dezocine on immune functions after pulmonary lobectomy

作　　者：艾玲[1] 鲁佩[1] 刘志恒[2] 罗爱林[1] 田玉科[1] 徐卉[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉科,湖北武汉430030 [2]深圳市第二人民医院麻醉科,广东深圳518035

出　　处：《中国医院药学杂志》2015年第13期1216-1220,共5页Chinese Journal of Hospital Pharmacy

基　　金：国家自然科学基金资助项目(编号:81341034);深圳市科技创新委员会国际合作项目(编号:GJHZ20120614154624545);深圳市科技创新委员会知识创新计划(编号:JCYJ2013041113227462)

摘　　要：目的:观察地佐辛静脉自控镇痛对肺叶切除术后免疫功能的影响。方法:选取60例拟行开胸肺叶切除术的患者随机分为对照组和DEZ组,每组30例。DEZ组术后PCA泵注0.5 mg·ml-1地佐辛,对照组术后PCA泵注0.9%氯化钠。采集患者麻醉诱导前(T0)、术后4 h(T1)、术后24 h(T2)和术后48 h(T3)血标本,测定血清CRP、TNF-α、IL-2、IL-6和IL-10水平,以及外周血淋巴细胞(L)计数及淋巴细胞中CD4+T淋巴细胞、CD8+T淋巴细胞、自然杀伤细胞(NK)比例的变化。于T1、T2和T3时点随访患者,记录患者视觉模拟评分(VAS)和数字镇静评分(NSS)。结果:肺叶切除术后患者血清CRP、TNF-α、IL-6和IL-10的水平较术前明显升高(P<0.05),IL-2较术前降低(P<0.05);术后外周血淋巴细胞计数及CD4+T淋巴细胞比例和NK细胞比例较术前降低(P<0.05);地佐辛静脉自控镇痛能明显降低术后血清CRP、IL-6,升高IL-2及CD4+T淋巴细胞比例(P<0.05);地佐辛组患者术后24 h的VAS评分低于对照组(P<0.05)。结论:地佐辛静脉镇痛具有免疫调节作用,可改善肺叶切除术后的免疫抑制,并减轻炎症反应。OBJECTIVE To investigate effects of patient controlled analgesia（PCA）with intravenous dezocine on immune function in patients after pulmonary lobectomy.METHODS A total of 60 patients scheduled for pulmonary lobectomy were randomly enrolled in this study.Patients were assigned to control group（PCA with 0.9% sodium chloride,n=30）and DEZ group（PCA with 0.5 mg·ml-1 dezocine,n=30）.Serum C-reactive protein（CRP）,tumor necrosis factor-α（TNF-α）,interleukin-2（IL-2）,interleukin-6（IL-6）,and interleukin-10（IL-10）were determined before induction of anesthesia（T0）,4 h after operation（T1）,24 h after operation（T2）and 48 h after operation（T3）.Blood samples were also analyzed for total lymphocyte count,and percentages of CD4＋T cells,CD8＋T cells and natural killer（NK）T cells.Visual analogue scale（VAS）and numeric sedation scale（NSS）were recorded at T1,T2 and T3.RESULTS The serum CRP,TNF-α,IL-6 and IL-10 increased remarkably after operation（P〈0.05）,while IL-2 was decreased（P〈0.05）.Total lymphocyte count and percentages of CD4＋T cells and NK cells decreased after operation（P〈0.05）.The serum CRP and IL-6 were significantly lower in DEZ group after operation（P〈0.05）,while serum IL-2 and percentage of CD4＋T cells were higher in DEZ group（P〈0.05）.VAS at 24 h after operation was lower in DEZ group（P〈0.05）.CONCLUSION PCA with dezocine has notable immunoregulating effects,which can alleviate immunosupression and inflammation after pulmonary lobectomy.

关 键 词：肺叶切除术 炎症因子 淋巴细胞 NK细胞 地佐辛 

分 类 号：R969.4[医药卫生—药理学]