地佐辛联合氟比洛芬酯术后多模式镇痛对胃癌根治术患者细胞免疫功能的影响

Effects of postoperative multimodal analgesia with dezocine and flurblprofen on cellular immune function in patients after radical gastric cancer surgery

目的观察地佐辛联合氟比洛芬酯术后多模式镇痛对胃癌根治术患者的镇痛效果及对免疫功能的影响。方法胃癌根治术患者40例,ASAⅠ或Ⅱ级,随机均分为地佐辛联合氟比洛芬酯组(DF组)和芬太尼组(F组),两组患者均行全凭静脉复合麻醉。两组患者术毕清醒后行静脉自控镇痛(PCIA),DF组镇痛泵配方为地佐辛30mg加氟比洛芬酯150mg,F组为芬太尼0.01mg/(d·kg),两组均加生理盐水配至100mL。初始负荷剂量4mL,背景剂量2mL/h,单次PCA剂量0.5mL,锁定时间15min。术后记录VAS评分、Ramsay镇静评分和不良反应的发生情况。分别于麻醉诱导前、术毕、术后1、3、5d抽血测定患者CD3+、CD4+、CD8+、CD4+/CD8+和自然杀伤细胞(NK细胞)水平。结果两组患者术后VAS评分、Ramsay镇静评分差异无统计学意义,DF组不良反应明显少于F组(P<0.05)。与麻醉前比,术毕两组患者CD3+、CD4+、CD4+/CD8+及NK细胞数量均下降(P<0.05),术后1d达最低水平(P<0.05)。术后3dDF组CD3+、CD4+、CD4+/CD8+及NK细胞数量已恢复到麻醉前水平,而F组仍明显低于麻醉前和DF组(P<0.05)。术后5d两组CD3+、CD4+、CD4+/CD8+及NK细胞数量均恢复至麻醉前水平。结论与芬太尼比较,地佐辛联合氟比洛芬酯术后镇痛效果满意且不良反应少,可减轻胃癌患者围术期T淋巴细胞亚群和NK细胞水平下降的程度,减轻术后细胞免疫功能的抑制。

Objective To investigate the effects of postoperative multimodal analgesia with dezocine and flurblprofen on postoperative analgesia and cellular immune function in patients after radical gastric cancer surgery.Methods Forty patients （ASA Ⅰ or Ⅱ grade） with gastric cancer undergoing radical gastrectomy in total intravenous anesthesia were randomly divided into two groups.The postoperative analgesics were dezocine and flurblprofen （group DF） or fentanil （group F）：group DF PCIA with dezocine 30 mg ＋ flurblprofen 150 mg; group F PCIA with fentanyl 0.01 mg/（d · kg）.Total PCIA volume was 100 mL saline with loading volume of 4 mL,background volume of 2 mL/h,bolus dose of 0.5 mL,and lockout interval of 15 min.The VAS score,Ramsay sedation score and the adverse events were recorded 2,24,48 h after surgery.Peripheral blood samples were obtained before anesthesia,at the end of operation,1,3 and 5 day after operation.The T-lymphocyte subsets （CD3＋,CD4＋,CD8＋,CD4＋/CD8＋） and natural killer cells （NK） were measured by flow cytometry.Results There was no significant difference in VAS score and Ramsay score between group DF and group F.Fewer adverse events were observed in group DF than in group F （P＜0.05）.The number of CD3＋,CD4＋,CD4＋/CD8＋ lymphocytes and NK cells decreased at the end of operation （P＜0.05） and significantly decreased one day after operation in both groups （P＜0.05）.In group DF,the number of CD3＋,CD4＋,CD4＋/CD8＋ lymphocytes and NK cells was recovered nearly to the baseline （before anesthesia） 3 days after operation,but in group F it was significantly lowed than the baseline or that in group DF （P＜0.05）.The whole T cells and NK cells recovered 5 days after operation in both groups.Conclusion Compared with fentanil,postoperative analgesia with dezocine and flurblprofen has a preferable therapeutic effect on postoperative pain and fewer adverse effects.It can reduce the inhibition of cellular immune function in patients undergoing radial gastrectomy.