右美托咪定复合舒芬太尼术后镇痛对肺癌患者免疫功能及肺部感染并发症的影响  

Effects of postoperative analgesia with Dexmedetomidine combined with Sufentanil on the immune function and complications of pulmonary infection in patients with lung cancer

作　　者：管丽丽 王焕亮[2] 张秀丽 张洪生 李静 Guan Lili;Wang Huanliang;Zhang Xiuli;Zhang Hongsheng;Li Jing(Department of Anesthesiology,the Second People's Hospital of Dezhou,Dezhou 253000,China;Department of Anesthesiology,Qilu Hospital of Shandong University,Ji'nan 250000,China)

机构地区：[1]山东省德州市第二人民医院麻醉科,253000 [2]山东大学齐鲁医院麻醉科,济南250000

出　　处：《中华老年医学杂志》2019年第10期1158-1161,共4页Chinese Journal of Geriatrics

基　　金：山东省科学技术发展委员会支持项目(2015ZRE27075)。

摘　　要：目的探讨右美托咪定复合舒芬太尼术后镇痛对肺癌患者肺部感染并发症和免疫功能的影响。方法选取2014年7月至2018年6月在我院行肺癌根治术的200例肺癌患者,按照随机数字表法将其分为A组100例和B组100例,A组术后单用舒芬太尼镇痛,B组联合舒芬太尼与右美托咪定镇痛,比较两组患者的镇痛和镇静效果、肺部并发症发生率以及免疫功能。结果B组患者术后4、8、12、24和48 h镇痛和镇静效果均优于A组,视觉模拟评分和Ramesay评分两组比较差异均有统计学意义(视觉模拟评分:t=4.137、2.575、3.869、12.676、9.945,均P<0.05;Ramesay评分:t=6.771、5.647、16.763、21.154、6.556,均P<0.05);B组患者肺部感染、急性肺损伤、局灶性肺浸润、肺不张、呼吸衰竭的发生例数分别为1例、0例、1例、1例、0例,A组则分别为3例、2例、3例、1例、1例;B组并发症发生率为3%(3/100),明显少于A组10%(10/100),两组比较差异有统计学意义(χ2=4.031,P=0.045);术前B组和A组患者CD3+、CD4+、CD8+和CD4+/CD8+细胞水平比较差异均无统计学意义(均P>0.05),术后1 d B组患者CD3+、CD4+、CD8+和CD4+/CD8+细胞水平明显高于A组(t=7.419、7.867、11.968、8.755,均P=0.000)。结论术后采取右美托咪定复合舒芬太尼镇痛不仅有助于减少行根治术治疗的肺癌患者肺部并发症发生率,同时还能提高其镇痛效果以及免疫功能。Objective To investigate the effects of postoperative analgesia with Dexmedetomidine combined with Sufentanil on pulmonary infection complications and immune function in patients with lung cancer.Methods A total of 200 patients with lung cancer who underwent radical lung cancer in our hospital from July 2014 to June 2018 were randomly divided into the group A(n=100,receiving Sufentanil analgesia)and group B(n=100,receiving Sufentanil combined with Dexmedetomidine analgesia)according to the random number table method.The analgesic effect,pulmonary complication incidence and immune function were compared between the two groups.Results The analgesic and sedative effects were better in the group B than in the group A at 4,8,12 and 24 hours after surgery,respectively(P<0.05).The visual analogue scale(VAS)and Ramesay score had statistically significant differences between the two groups at 4,8,12 and 24 hours after surgery,respectively(VAS:t=4.137,2.575,3.869,12.676 and 9.945,all P<0.05;Ramesay score:t=6.771,5.647,16.763,21.154 and 6.556,all P<0.05).The pulmonary infection,acute lung injury,focal lung infiltration,atelectasis and respiratory failure occurred in 1,0,1,1 and 0 case in the group B and 3,2,3,1 and 1 case in the group A,respectively.The incidence of pulmonary complications was lower in the group B than in the group A(3%or 3/100 vs.10%or 10/100,χ2=4.031,P=0.045).There were no significant difference in the levels of CD3+,CD4+,CD8+and CD4+/CD8+cells before surgery between the two groups(P>0.05).The levels of CD3+,CD4+,CD8+and CD4+/CD8+cells were higher in group B than in group A at 1 day after surgery(t=7.419,7.867,11.968 and 8.755,P=0.000).Conclusions Postoperative Dexmedetomidine combined with Sufentanil analgesia not only helps to reduce the incidence of pulmonary complications,but also improves the analgesic effect and immune function in patients with lung cancer undergoing radical surgery.

关 键 词：肺肿瘤 右美托咪啶 舒芬太尼 麻醉和镇痛 

分 类 号：R73[医药卫生—肿瘤]