艾司氯胺酮复合舒芬太尼自控静脉镇痛对胸腔镜肺癌根治患者术后疲劳及免疫功能的影响  

Effects of esketamine combined with sufentanil in PCIA on fatigue and immune function after thoracoscopic radical resection of lung cancer

作　　者：王金凤[1,2] 徐海军[1,2] 戚钰[1,2] 周海 王立伟 WANG Jin-feng;XU Hai-jun;QI Yu;ZHOU Hai;WANG Li-wei(Department of Anesthesiology,Xuzhou Central Hospital,Xuzhou 221000,Jiangsu,China;Jiangsu Key Laboratory of Anesthesiology,Xuzhou 221004,Jiangsu,China)

机构地区：[1]徐州市中心医院麻醉科,徐州221000 [2]江苏省麻醉学重点实验室,徐州221004

出　　处：《中国临床医学》2022年第6期982-986,共5页Chinese Journal of Clinical Medicine

基　　金：江苏省麻醉重点实验室开放课题(XZSYSKF2021011);徐州市科技创新重点研发计划(KC21251)。

摘　　要：目的探讨艾司氯胺酮复合舒芬太尼自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)对胸腔镜肺癌根治患者术后疲劳及免疫功能的影响。方法选择2021年10月至2022年8月在徐州市中心医院择期行胸腔镜肺癌根治术的患者120例,随机分为艾司氯胺酮^(+)舒芬太尼PCIA组(E组,n=60,艾司氯胺酮1.5 mg/kg、舒芬太尼1.0μg/kg)和舒芬太尼PCIA组(C组,n=60,舒芬太尼2.0μg/kg)。于麻醉诱导前、术后24 h、术后48 h、术后72 h,采用疲劳标尺模型(Christensen评分)和围术期疲劳评测量表(identity-consequence fatigue scale,ICFS)评估患者疲劳情况,采用疼痛数字评定量表(numerical rating scale,NRS)评估镇痛情况,检测外周血T细胞因子(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))和补体C3、C4。记录患者不良反应发生情况。结果与C组相比,E组患者术后24、48 h的Christensen和ICFS评分降低(P<0.05)。与C组相比,E组患者术后24、48、72 h的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、C3、C4均升高(P<0.05)。E组患者恶心、呕吐、瘙痒发生率低于C组(P<0.05)。两组患者疼痛评分差异无统计学意义。结论对于接受胸腔镜肺癌根治术的患者,艾司氯胺酮联合舒芬太尼PCIA能减轻患者术后疲劳,降低不良反应发生率,并改善T细胞免疫功能。Objective To investigate the effect of esketamine combined with sufentanil in patient-controlled intravenous analgesia(PCIA)on fatigue and immune function of patients after thoracoscopic radical resection of lung cancer.Methods A total of 120 patients undergoing thoracoscopic radical resection of lung cancer in Xuzhou Central Hospital from October 2021 to August 2022 were randomly divided into two groups:group E(PCIA with esketamine 1.5 mg/kg and sufentanil 1.0μg/kg,n=60)and group C(PCIA with sufentanil 2.0μg/kg,n=60).Before anesthesia,24 h,48 h and 72 h after surgery,fatigue scale model(Christensen score)and identity-consequence fatigue scale(ICFS)were used to evaluate patients’fatigue.Numerical rating scale(NRS)was used to evaluate analgesia efficiency.Peripheral blood T cytokines(CD3^(+),CD4^(+),CD4^(+)/CD8^(+))and complement C3 and C4 were measured.The adverse reactions were recorded.Results Compared with group C,the scores of Christensen and ICFS in group E were lower at 24 h and 48 h after operation(P<0.05).Compared with group C,the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+),C3 and C4 in group E were higher at 24 h,48 h,72 h after operation(P<0.05).The incidences of nausea,vomiting and pruritus in group E were lower than those in group C(P<0.05).There was no significant difference in NRS between the two groups.Conclusion For patients undergoing thoracoscopic radical resection of lung cancer,esketamine combined with sufentanil in PCIA can relieve postoperative fatigue,reduce the adverse reactions,and improve T cell immune function.

关 键 词：艾司氯胺酮 舒芬太尼 疲劳 患者自控静脉镇痛 免疫功能 

分 类 号：R734.2[医药卫生—肿瘤]