地佐辛联合芬太尼在乳腺癌术后自控静脉镇痛中的应用价值

Value of Dezocine combining Fentanyl used for postoperative PCIA in breast cancer patients

目的探讨地佐辛联合芬太尼在乳腺癌术后自控静脉镇痛中的意义。方法选择美国麻醉协会分级I一Ⅲ级行乳腺癌手术治疗的患者126例，均采用气管插管复合静脉麻醉，术后行自控静脉镇痛。患者按均衡随机分组的方法分为对照组和研究组，对照组（63例）术后仅行芬太尼静脉镇痛，研究组（63例）术后采用地佐辛联合芬太尼静脉镇痛。观察两组患者术后12、24及48h的疼痛评分、镇静评分和舒适度评分。并比较两组患者术后自控静脉镇痛的不良反应发病率。分别于术前1天和术后第1大、第7天观察患者T细胞亚群和IL-2水平的变化。结果在各时间点，研究组视觉模拟评分明显低于对照组，镇静效果评分明显高于时照组（P〈0．05）。两组舒适度评分差异无统计学意义（P〉0．05）。对照组和研究组不良反应发病率差异无统计学意义（P〉0．05）。术前1天、术后第1天，研究组与对照组CD4＋、CD8＋T细胞、CD4＋／CD8＋、IL-2比较差异均无统计学意义（P〉0．05）。术后第7天，对照组CD4＋、CD4＋／CD8＋、IL-2分别为（45．68±5．82）％、（1．45±0．25）、（1．51±0．37）μg/L，研究组CD4＋、CD4＋／CD8＋、IL-2分别为（52．35±6．34）％、（1．82±0．31）、（1．75±0．48）μg/L，与对照组比较，研究组CD4＋、CD4＋／CD8＋、IL-2明显升高（P〈0．05）；而对照组和研究组CD8＋T细胞比例分别为（26．25±3．37）％、（21．23±2．78）％，二者之间差异有统计学意义（P〈0．05）。结论地佐辛联合芬太尼用于乳腺癌术后自控静脉镇痛可以提高静脉镇痛的效果，减少静脉镇痛的不良反应，对患者术后免疫功能的改善也有积极的作用。

Objective To investigate the significance of Dezocine combining Fentanyl used for postoperative PCIA in breast cancer patients. Methods One hundred and twenty six patients with ASA Ⅰ-Ⅲ entered the study. All patients were scheduled for breast cancer operation under intravenous analgesia with tube insertion and treated with PCIA after the operation. They were randomly divided into Fentanyl group （n = 63 ） and Dezocine combining Fentanyl group（n =63）. VAS, Ramsay, BCS in two groups were compared at 12 h, 24 h, 48 h after operation. Side effect was also detected. The changes of T cell subset and IL-2 were analyzed in the patients respectively at the first day before operation, at the first day after operation, at the seventh day after operation. Results At every time point, VAS in research group was significantly lower than that in control group （ P 〈 0.05 ）. However, Ramsay in research group was obviously higher than that in control group（ P 〈 0.05 ）. There were no significant differences in BCS between two groups （ P 〉 0.05 ）. And no difference was found in the incidence of side effect between two groups （P 〉 0.05 ）. Compared with control group, the changes of T cell subset, IL-2 had no significant differences in research group at the first day after operation and at the first day before operation（ P 〉 0.05 ）. At the seventh day after operation, the levels of CD4＋ , CD4 ＋/CD8＋ , IL-2 in research group were obviously higher than those in control group（ P 〈 0.05 ）. However, the percentage of CD8＋ T cells in research group was significantly lower than that in control group （ P 〈 0.05 ）. Conclusions Dezocine combining Fentanyl in PCIA can increase analgesia effect with less side effect. It is positive to improve immunologic function for breast carcinoma patients after operation.