术后静脉镇痛对肺癌手术患者围术期免疫反应及儿茶酚胺的影响

Effect of flurbiprofen axetil combined with sufentanyl on perioperative immune response and catecholamine in patients undergoing lung cancer surgery

目的观察联合应用氟比洛芬酯和舒芬太尼术后静脉镇痛对肺癌手术患者围术期免疫反应及儿茶酚胺的影响。方法选择择期行肺癌根治术患者26例,ASAⅠ-Ⅱ级,随机分为氟比洛芬酯联合舒芬太尼镇痛组(F组,n=13)和舒芬太尼镇痛组(S组,n=13)。两组患者均采用相同的异丙酚、芬太尼、维库溴铵及异氟醚静吸复合麻醉。术毕分别用氟比洛芬酯联合舒芬太尼和单纯舒芬太尼行静脉术后镇痛,采用VAS镇痛评分评价镇痛效果,并分别于于麻醉前(T0)、切皮后1h(T1)和术毕(T2)、术后24h(T3)、48h(T4)检测外周血CD3、CD4、CD8、CD2+3B细胞及单核细胞HLA-DR表达的变化。同时测定外周血肾上腺素(E)、去甲肾上腺素(NE)的浓度。结果两组术后镇痛效果无显著性差异(P>0.05)。S组切皮后1h及术毕CD3细胞下降,术后24hCD4细胞和CD4/CD8比值降低(P<0.05),F组切皮后1hCD4/CD8升高(P<0.05)。两组术后24hCD2+3B细胞均显著升高,单核细胞HLA-DR表达显著下(P<0.05)降。两组在术中、术后NE值无显著差异(P>0.05)。结论氟比洛芬酯联合舒芬太尼和单纯舒芬太尼术后镇痛都取得良好的镇痛效果,但前者更有利肺癌患者术后细胞免疫功能的恢复。

Objective To evaluate the effect of postoperative analgesia with flurbiprofen axetil combined with sufentany] on perioperative immune response and catecholamine in patients undergoing lung cancer surgery. Methods Twenty-six patients ASA Ⅰ-Ⅱ patients aged 46-73years undergoing radical operation of lung cancer were randomly assigned into two groups ： F group and S group. All patients were given identical intravenous combined with inhalational anesthesia with propofo], fentanyl, vecuronium and isoflurane. Then patients received post-operative analgesia with flurbiprofen axeti] combined with sufentanyl after operation in F group, but only sufentanyl in S group. Peripheral blood CD3, CD4, CD8, CD23＋ B and HLA-DR on monocyte were measured before induction of anesthesia （ T1 ）, 1 h after incision （ T2）, 24 h （ T3 ） and 48 h （T4） after the completion of the surgery. Peripheral blood epinephrine （E） and norepinephrine （NE） were observed in the same time. Results There was no significant difference in visual analogue scale （VAS） between F group and S group. In CD3% decreased at T2 and CD4%, CD4/CD8 ratio decreased at 33 in the group S, but not in the group F. CDJCDs ratio increased at T2 in group S. CD23＋ B% lymphocyte increased and fluorescene of HLA-DR expression on monocyte decreased significantly in both groups. Blood NE level in group C didn＇ t significantly differ from that in group G during and after operation. Conclusion Postoperative analgesia with flurbip refen axetil and sufentanyl orwith sufentanyl alone shows a similar postoperative analgesic effect in patients undergoing radical operation of lung cancer, but the former protocol more contributes to recover cell-mediated immunity of the patients.