纳布啡联合罗哌卡因切口局部浸润对儿童术后疼痛、应激反应和免疫功能的影响  

Effects of local incision infiltration anesthesia of nalbuphine combined with ropivacaine on postoperative pain,stress response and immune function in children

作　　者：文婷婷[1] 李秀泽[1] Wen Tingting;Li Xiuze(Department of Anesthesiology,Mianyang Central Hospital,Sichuan,Mianyang 621000,China)

机构地区：[1]绵阳市中心医院麻醉科,四川绵阳621000

出　　处：《中国医学前沿杂志（电子版）》2020年第9期110-113,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：四川省卫生和计划生育委员会科研课题(17PJ232)。

摘　　要：目的分析纳布啡联合罗哌卡因切口局部浸润对儿童术后疼痛、应激反应和免疫功能的影响。方法选取2018年7月至2019年6月于绵阳市中心医院行开腹手术的60例患儿为研究对象,按照密封信封法将其随机分为对照组和研究组,每组各30例,手术均采用静脉-吸入复合麻醉。对照组患儿缝合切口前以0.25%罗哌卡因行切口局部浸润,研究组患儿术前静脉滴注0.2 mg/kg纳布啡,并于缝合切口前以0.25%罗哌卡因行切口局部浸润。比较两组患儿术后疼痛情况[儿童疼痛评估量表FLACC(face,legs,activity,crying,consolability scale)]、应激反应指标(血清皮质醇、肾上腺素、去甲肾上腺素)、免疫功能指标(CD3^+T细胞、CD4^+T细胞、CD8^+T细胞水平和CD4^+T细胞/CD8^+T细胞比值)及不良反应发生情况。结果两组患儿术后24 h内FLACC评分整体呈下降趋势,组内比较差异均有统计学意义(均P<0.05)。研究组患儿术后苏醒时及术后1 h、6 h、12 h、24 h的FLACC评分均显著低于同期对照组(均P<0.05)。术后24 h,两组患儿皮质醇、肾上腺素、去甲肾上腺素水平均显著高于本组术前(均P<0.05),CD3^+T细胞、CD4^+T细胞、CD8^+T细胞水平均显著低于本组术前(均P<0.05),且研究组患儿皮质醇、肾上腺素、去甲肾上腺素水平均显著低于同期对照组(均P<0.05),CD3^+T细胞、CD4^+T细胞、CD8^+T细胞水平和CD4^+T细胞/CD8^+T细胞比值均显著高于同期对照组(均P<0.05)。研究组患儿不良反应发生率显著低于对照组(P<0.05)。结论纳布啡联合罗哌卡因切口局部浸润能够减轻儿童术后疼痛,减少应激反应,有利于免疫功能的恢复。Objective To explore the the effects of local incision infiltration anesthesia of nalbuphine combined with ropivacaine on postoperative pain,stress response and immune function in children.Method A total of 60 children who underwent laparotomy from July 2018 to June 2019 in Mianyang Central Hospital were selected and randomly divided into control group and study group,with 30 cases in each group.All surgery were performed under combined intravenous and inhalation anesthesia.The children in control group were given 0.25%ropivacaine for local infiltration anesthesia before incision suture,the children in study group were intravenously injected 0.2 mg/kg nalbuphine before operation,and the incision was infiltrated with 0.25%ropivacaine before incision suture.The postoperative pain[child pain assessment scale FLACC(face,legs,activity,crying,consolability scale)],stress response indexes(serum cortisol,adrenaline,noradrenaline),immune function indexes(levels of CD3^+T cell,CD4^+T cell,CD8^+T cell and the ratio of CD4^+T cell/CD8^+T cell)and adverse reactions were compared between the two groups.Result The FLACC scores of the two groups showed a downward trend within 24 hours after operation,and there were significant differences between the two groups(all P<0.05).The FLACC scores of children in study group at the time of postoperative awakening and at 1 h,6 h,12 h and 24 h after operation were significantly lower than those in control group(all P<0.05).24 h after operation,the levels of cortisol,adrenaline,noradrenaline in the two groups were significantly higher than those of the group before operation(all P<0.05),and the levels of CD3^+T cells,CD4^+T cells,and CD8^+T cells were significantly lower than this group before operation(all P<0.05).The levels of cortisol,adrenaline,noradrenaline in study group were significantly lower than those in control group(all P<0.05),while the levels of CD3^+T cells,CD4^+T cells,CD8^+T cells and the ratio of CD4^+T cells/CD8^+T cells in study group were significantly higher than thos

关 键 词：纳布啡 罗哌卡因 儿童 局部浸润 应激 免疫 

分 类 号：R726.1[医药卫生—儿科]