右美托咪定复合吗啡PCIA用于开胸手术术后镇痛对机体免疫细胞的影响  

Influence of dexmedetomidine combined with morphine PCIA after thoracic surgery on immune cells

作　　者：雷鹏飞[1] 高杉[1] 杜增利[2] 

机构地区：[1]新乡医学院附属新乡市中心医院麻醉科,453000 [2]焦煤集团中央医院麻醉科

出　　处：《临床麻醉学杂志》2015年第10期945-948,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨右美托咪定复合吗啡PCIA用于开胸手术术后镇痛对机体免疫细胞的影响。方法选择2012年3月至2014年4月在我院行开胸手术的患者112例,男53例,女59例,年龄41~60岁,ASAⅠ或Ⅱ级,随机分为复合组和吗啡组,其中,复合组51例,男26例,女25例,吗啡组61例,男27例,女34例,术毕苏醒、气管导管拔除后,主诉疼痛者（VAS评分〉4分）行PCIA。PCIA给药方案：复合组患者给予含1.0μg/kg右美托咪定和0.48mg/kg吗啡的药液150ml,吗啡组患者则给予含0.48mg/kg吗啡的药液150 ml,负荷量2 ml,背景输注速率2 ml/h,锁定时间15min,维持术后疼痛VAS评分≤3分。分别于麻醉诱导前（T0）、气管导管拔除即刻（T1）、术后12h（T2）、术后24h（T3）、术后48h（T4）、术后72h（T5）及术后7d（T6）,利用FACSCalibur流式细胞仪对外周血中CD3＋、CD4＋、CD8＋淋巴细胞亚群及NK细胞含量进行检测,并计算CD4＋/CD8＋值,记录T3~T5时的吗啡用量,术后7d患者不良反应发生情况。结果复合组患者术后T2~T5时VAS评分均明显低于吗啡组（P〈0.05）,复合组患者术后T3~T5时吗啡用量均明显低于吗啡组（P〈0.05）;复合组患者术后瘙痒、恶心和呕吐发生率均明显低于吗啡组（P〈0.05）;与T0时比较,两组患者T1~T5时CD3＋、CD4＋、CD4＋/CD8＋和NK细胞水平均降低。复合组患者T2~T5时CD3＋水平和CD4＋/CD8＋均明显高于吗啡组,复合组患者T3~T5时CD4＋和NK细胞水平均明显高于吗啡组（P〈0.05）。结论右美托咪定复合吗啡PCIA用于开胸手术术后镇痛可有效减少吗啡用量,降低镇痛时不良反应发生,改善患者细胞免疫功能。Objective To investigate the influence of dexmedetomidine combined with morphine intravenous analgesia by patient controll（PCIA）after thoracic surgery on immune cells.Methods One hundred and twelve cases of patients undergoing thoracic surgery in our hospital from March 2012 to April 2014 were selected（male 53 cases,female 59 cases,aged 41~60years,ASA ⅠorⅡ grade）.All cases were randomly divided into complex group（51cases）and morphine group（61cases）.26 males and 25 females were in complex group.27 males and 34 females were in the morphine group.PCIA were carried out if patients complained of pain（score of VAS〉4）after extubation postoperatively.Patients in complex group were given 150 ml of liquid containing 1.0μg/kg dexmedetomidine and 0.48mg/kg of morphine.In morphine group same volume of liquid containing 0.48mg/kg of morphine only.The loading dose was 2ml,background infusion rate was 2mL/h,locking time was 15 min,and maintaining VAS score≤3.CD3＋,CD4＋and CD8＋lymphocyte subsets and NK cell levels in peripheral blood were detected by using FACSC alibur flow cytometer on the following time points：before the induction of anesthesia（T0）,immediately after extubation（T1）,12h（T2）,24h（T3）,48h（T4）,72h（T5）and 7d（T6）postoperatively.The dosages of morphine on T3-T5 were recorded.Incidences of adverse reactions of the two groups 7days after surgery were compared.Results On T2-T5,VAS scores in the complex group were significantly lower than that in the morphine group（P〈0.05）.On T3-T5,the dosages of morphine in the complex group were significantly lower than in the morphine group（P〈0.05）.The incidences of pruritus,nausea and vomiting after operation in complex group were significantly lower than the morphine group（P〈0.05）.Compared with T0,the levels of CD3＋、CD4＋、CD4＋/CD8＋ratio and NK cells of two groups were dropped.Compared with morphine group,on T2-T5,the levels of CD3＋and CD4＋/CD8＋ratios in complex group were higher than the

关 键 词：开胸手术 右美托咪定 吗啡 镇痛 免疫细胞 

分 类 号：R614[医药卫生—麻醉学]