艾司氯胺酮联合舒芬太尼术后自控镇痛对脊柱手术患者疼痛、应激激素及免疫功能的影响  

Effects of Esketamine Combined with Sufentanil for Postoperative Patient-Controlled Analgesia on Pain,Stress Hormones and Immune Function in Patients Undergoing Spinal Surgery

作　　者：吴瑞阳 韩灵龙 WU Rui-yang;HAN Ling-long(Surgery Department,Department of Anesthesiology,Xuchang Central Hospital,Xuchang 461000,China)

机构地区：[1]许昌市中心医院麻醉科手术部,许昌461000

出　　处：《中国合理用药探索》2024年第7期81-88,共8页Chinese Journal of Rational Drug Use

摘　　要：目的:探讨艾司氯胺酮联合舒芬太尼术后自控镇痛对脊柱手术患者免疫功能、炎症因子、疼痛物质及应激激素的影响。方法:选取2021年6月~2023年6月期间某院收治的100例行胸、腰椎骨折内固定术患者作为研究对象,采用随机数字表法分为对照组和观察组,每组50例。术后两组患者均给予注射用盐酸托烷司琼以预防恶心呕吐,对照组患者术后给予枸橼酸舒芬太尼注射液,观察组在对照组基础上加用盐酸艾司氯胺酮注射液。比较两组患者术后镇痛效果[视觉模拟评分法(VAS)]、血压及心率、疼痛物质[P物质(SP)、5-羟色胺(5-HT)、β-内啡肽(β-EP)]、应激激素[皮质醇(Cor)、去甲肾上腺素(NE)]、免疫功能[CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、自然杀伤细胞(NK cell)]、炎症因子[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]及不良反应发生情况。结果:观察组患者术后4、8、16h和24h的VAS评分均低于对照组(P<0.05);两组患者术后30min、2h和4h的收缩压、舒张压和心率比较均无统计学差异(P>0.05);观察组患者术后24h和48h的SP、NE、5-HT和Cor水平均低于对照组(P<0.05),β-EP水平高于对照组(P<0.05);术后24h和48h的CD3^(+)、CD4^(+)、NK cell及CD4^(+)/CD8^(+)均高于对照组(P<0.05),CD8^(+)低于对照组(P<0.05);术后24h和48h的IL-6和TNF-α水平均低于对照组(P<0.05)。两组患者不良反应率比较无统计学差异(P>0.05)。结论:脊柱手术后给予患者艾司氯胺酮联合舒芬太尼镇痛效果较好,可有效减轻患者疼痛,降低机体应激及炎症反应,改善免疫功能,且不会增加患者不良反应的发生风险。Objective:To investigate the effects of esketamine combined with sufentanil used for postoperative patient-controlled analgesia on immune function,inflammatory factors,pain substances and stress hormone in patients undergoing spinal surgery.Methods:A total of 100 patients with internal fixation of thoracic and lumbar fractures admitted to a hospital from June 2021 to June 2023 were selected as the study objects,and were divided into control group and observation group by random number table method,with 50 cases in each group.Postoperatively,patients in both groups were given tropisetron hydrochloride for injection to prevent nausea and vomiting.The control group was given sufentanil citrate injection after surgery,while the observation group was given esketamine hydrochloride injection in addition to the control group.Compare the postoperative analgesic effects[visual analog scale(VAS)],blood pressure and heart rate,pain substances[substance P(SP),5-hydroxytryptamine(5-HT),β-endorphin(β-EP)],stress hormones[cortisol(Cor),norepinephrine(NE)],immune function[CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),natural killer cell(NK cell)],inflammatory factors[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)],and incidence of adverse reactions between the two groups.Results:The VAS scores at 4h,8h,16h and 24h after operation were lower in the observation group than those in the control group(P<0.05).There was no statistically significant difference in systolic blood pressure,diastolic blood pressure and heart rate at 30min,2h and 4h after operation between the two groups(P>0.05).The levels of SP,NE,5-HT and Cor in observation group were lower than those in control group at 24h and 48h after operation(P<0.05),and the levels ofβ-EP were higher than those in control group(P<0.05).The CD3^(+),CD4^(+),NK cell and CD4^(+)/CD8^(+)in observation group were higher than those in control group at 24h and 48h after operation(P<0.05),and CD8^(+)were lower than those in control group(P<0.05).The levels of IL-6 and TNF-αat 24h and 48h

关 键 词：艾司氯胺酮 舒芬太尼 自控镇痛 脊柱手术 免疫功能 

分 类 号：R614[医药卫生—麻醉学]