羟考酮静脉自控镇痛对宫颈癌根治术患者术后疼痛、应激反应、炎症反应及免疫功能的影响

Effects of oxycodone patient-controlled intravenous analgesia on postoperative pain, stress response, inflammatory response and immune function of patients undergoing radical cervical cancer surgery

目的探讨羟考酮静脉自控镇痛(PCIA)对宫颈癌根治术后患者疼痛、应激反应、炎症反应及免疫细胞功能的影响。方法选择2018年4月至2020年4月期间120例择期宫颈癌根治术患者为研究对象,随机分为对照(芬太尼PCIA)和观察(羟考酮PCIA)组,每组各60例。分别于术前(T_(0))、术后PCIA开始前(T_(1))及PCIA开始后12 h(T_(2))、24 h(T_(3))、48 h(T_(4)),采用视觉模拟评分法(VAS)评估患者疼痛程度;采集患者外周血,采用放射免疫法测定致痛因子5-羟色胺(5-HT)、P物质(SP)、前列腺素(PG),应激激素皮质醇(Cor)、生长激素(GH)及去甲肾上腺素(NE)水平,酶联免疫吸附法检测血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-10(IL-10)和血浆高迁移率族蛋白B1(HMGB1)含量;流式细胞术检测CD4^(+)和CD8^(+)T淋巴细胞及NK细胞含量。结果与对照组相比,观察组T_(2)~T_(4)时,VAS评分、SP、5-HT和PG、T_(3)~T_(4)时Cor、GH、NE、TNF-α、IL-6、HMGBl和CD8^(+)细胞比例和不良反应发生率降低,IL-10、CD4^(+)细胞和NK细胞比例升高(均P<0.05)。结论羟考酮静脉自控镇痛具有更明显的镇痛效果,并能够缓解全身应激,调节机体免疫状态,降低不良反应发生率,是一种有效的术后镇痛方式。

AIM To investigate the effects of oxycodone patient-controlled intravenous analgesia(PCIA)on pain,stress response,inflammatory response and immune cell function in patients after radical resection of cervical cancer.METHODS A total of 120 patients undergoing elective radical resection of cervical cancer from April 2018 to April 2020were selected as study subjects and randomly divided into observation group(oxycodone PCIA group)and control group(fentanyl PCIA group),with 60 patients in each group.Visual analogue scale(VAS)was used to evaluate the pain degree of patients before operation(T_(0)),before operation(T_(1))and 12 h(T_(2)),24 h(T_(3))and 48 h(T_(4))after PCIA.Peripheral blood was collected from patients.Radioimmunoassay was used to determine the expression levels of pain-causing factors 5-hydroxytryptamine(5-HT),substance P(SP),prostaglandin(PG),stress hormones cortisol(Cor),growth hormone(GH)and norepinephrine(NE).The contents of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-10(IL-10)and plasma high mobility group box-1 protein(HMGB1)were detected by ELISA.CD4^(+)and CD8^(+)T lymphocytes and NK cells were detected by flow cytometry.RESULTS Compared with the control group,VAS score,SP,5-HT and PG,Cor,GH,NE,TNF-α,IL-6,HMGBl and CD8^(+)cells and the incidence of adverse reactions in the observation group were lower,and the percentages of IL-10,CD4^(+)cells and NK cells were higher(all P<0.05).CONCLUSION Oxycodone PCIA has more obvious analgesic effect.It can relieve systemic stress,regulate the immune state of the body,and reduce the incidence of adverse reactions.It is an effective postoperative analgesia method.