纳布啡PCIA对肝癌切除术患者术后细胞免疫功能的影响  

Effects of PCIA with nalbuphine on postoperative cellular immune function in patients undergoing liver cancer resection

作　　者：李涛[1] 高晨 柴小青 疏树华 周玲[1] 谢言虎 Li Tao;Gao Chen;Chai Xiaoqing;Shu Shuhua;Zhou Ling;Xie Yanhu(Department of Anesthesiology,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院麻醉科,合肥230001

出　　处：《中华麻醉学杂志》2019年第11期1357-1359,共3页Chinese Journal of Anesthesiology

基　　金：湖北陈孝平科技发展基金会人福围术期镇痛药研究纳布啡专项基金(CXPJJH118000017-02-03)。

摘　　要：目的评价纳布啡PCIA对肝癌切除术患者术后细胞免疫功能的影响。方法择期全麻下行肝癌切除术患者80例,性别不限,年龄40~64岁,BMI 19~25 kg/m^2,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=40):舒芬太尼PCIA组(S组)和纳布啡PCIA组(N组)。2组关腹前行腹横肌平面阻滞。S组手术结束前30 min静脉注射舒芬太尼0.1μg/kg,术毕采用舒芬太尼2μg/kg+昂丹司琼16 mg行PCIA,用生理盐水稀释至100 ml,背景剂量2 ml/h,PCA剂量1 ml,锁定时间10 min。N组手术结束前30 min静脉注射纳布啡0.1 mg/kg,术毕采用纳布啡2 mg/kg+昂丹司琼16 mg行PCIA,用生理盐水稀释至100 ml,背景剂量2 ml/h,PCA剂量1 ml,锁定时间10 min,维持术后48 h内VAS评分<4分。分别于入室时(T1)和术后24、72 h(T2,3)时抽取右颈内静脉血标本,采用流式细胞术测定T细胞亚群CD3^+、CD4^+、CD8^+、B细胞和NK细胞水平,计算CD4^+/CD8^+比值。结果与S组比较,N组T2时CD3^+细胞、CD4^+细胞水平升高,T3时CD4^+细胞和NK细胞水平升高(P<0.05)。与T1时比较,2组T2时CD3^+细胞、CD4^+细胞、NK细胞和B细胞水平降低,T3时NK细胞水平降低,S组T2时CD4^+/CD8^+比值降低(P<0.05)。与T2时比较,T3时S组CD3^+细胞水平升高(P<0.05)。结论纳布啡PCIA可改善肝癌切除术患者术后细胞免疫功能。Objective To evaluate the effects of patient-controlled intravenous analgesia(PCIA)with nalbuphine on postoperative cellular immune function in the patients undergoing liver cancer resection.Methods Eighty hepatoma patients of both sexes,aged 40-64 yr,with body mass index 19-25 kg/m^2,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,undergoing elective liver cancer resection,were divided into 2 groups(n=40 each)using a random number table method:sufentanil PCIA group(S group)and nalbuphine PCIA group(N group).Transverse abdominal plane block was performed in two groups.In group S,sufentanil 0.1μg/kg was intravenously injected at 30 min before the end of surgery,PCIA was performed with sufentanil 2μg/kg plus ondansetron 16 mg(diluted to 100 ml in normal saline)at the end of surgery,and PCA pump was set up with a 1 ml bolus dose,a 10-min lockout interval and background infusion at a rate of 2 ml/h.In group N,nalbuphine 0.1 mg/kg was intravenously injected at 30 min before the end of surgery,PCA was performed with nalbuphine 2 mg/kg plus ondansetron 16 mg(diluted to 100 ml in normal saline)at the end of surgery,and PCIA pump was set up with a 1 ml bolus dose,a 10-min lockout interval and background infusion at a rate of 2 ml/h,maintaining visual analog scale score<4 within 48 h after surgery.Blood samples were collected from the right internal jugular vein on admission to operating room(T1)and 24 and 72 h after surgery(T2,3)for measurement of levels of T lymphocyte subsets CD3^+,CD4^+ and CD8^+,B cells and NK cells.CD4^+/CD8^+ ratio was calculated.Results Compared with S group,levels of CD3^+ and CD4^+ cells at T2 and levels of CD4^+ and NK cells at T3 were significantly increased in N group(P<0.05).Compared with the baseline at T1,the levels of CD3^+,CD4^+,NK and B cells at T2 and NK cells at T3 were significantly decreased in two groups,and CD4^+/CD8^+ ratio was decreased at T2 in group S(P<0.05).Conclusion PCIA with nabuphine can improve the postoperative cellular immune function in the patie

关 键 词：纳布啡 镇痛 病人控制 免疫 细胞 

分 类 号：R614[医药卫生—麻醉学] R735.7[医药卫生—外科学]