摘要
目的比较不同剂量芬太尼对胃癌患者术后镇痛效果及免疫功能的影响。方法30例胃癌择期手术的病人,术后镇痛予芬太尼静脉持续输注,随机分成三组,每组10例。Ⅰ组芬太尼剂量为5μg/ml,Ⅱ组为10μg/ml,Ⅲ组为15μg/ml。分别在术后4、24、48h观察病人的镇痛效果、镇痛评分(VAS法);并且在麻醉前、术后1d和7d抽取静脉血,用流式细胞仪测定T细胞亚群和NK细胞的数量。结果Ⅰ组镇痛效果不完善,VAS评分明显高于Ⅱ、Ⅲ组P<0.01,Ⅱ组和Ⅲ组镇痛良好。三组病人术后1d体内CD4+、CD4+/CD8+、NK细胞数量均明显下降,与麻醉前相比,Ⅰ、Ⅱ组P<0.05,Ⅲ组下降最显著P<0.01;术后7d各组数据均恢复至术前水平。结论三组对比,Ⅰ组镇痛效果不理想;Ⅲ组术后一过性免疫抑制的程度最明显;Ⅱ组既可取得良好的镇痛效果,术后引起的免疫抑制程度又相对较轻,因此建议芬太尼术后静脉镇痛剂量控制在10μg/ml左右最为安全可靠。
Objective To evaluate the effects of different doses of fentanyl on postoperative analgesia and immune function in patients with gastric carcinoma. Methods Thirty patients undergoing elective gastrectomy for cancer were randomly assigned into three groups with 10 cases each. All patients received postoperative analgesia with intravenous fentanyl. The dose of fentanyl was 5μg/ml in groupⅠ, 10μg/ml in groupⅡand 15μg/ml in group Ⅲ respectively. Pain rating, sedation score (VAS) were recorded at 4, 24 and 48h of post operation. Peripheral venous blood samples were taken before anesthesia and on the 1st and 7th postoperative day for determination of subsets of T-lymphocyte CD4+, CD8+, CD4+ /CD8+ and NK cells by flow cytometery. Result The VAS of groupⅠwas significantly higher than those of groupⅡand Ⅲ, P<0.01. The effects of analgesia were satisfactory in groupⅡand Ⅲ. The numbers of CD4+, CD4+ /CD8+ and NK cells decreased on the 1st postoperative day in the three groups compared with those before anesthesia. However, the most significant differences were found in group Ⅲ, P<0.01; compared to those in groupⅠand Ⅱ, P<0.05. On the 7th postoperative day, the CD4+, CD4+ /CD8+ and NK cells returned to the preoperative levels in all groups. Conclusion GroupⅠcan not provide an effective analgesia and group Ⅲ has transient inhibitory effects on immune function. Only groupⅡhas a better analgesia and less effect on the degree of immunosuppression. So 10μg/ml of fentanyl is the best choice for postoperative analgesia in these cases.
出处
《泰州职业技术学院学报》
2004年第6期40-42,45,共4页
Journal of Taizhou Polytechnic College
