右美托咪定复合瑞芬太尼用于肺癌切除术后的镇痛效果及对机体免疫功能的影响

Postoperative Analgesic Effect of Dexmedetomidine Combined with Remifentanil on Lung Cancer Resection and Its Effect on Immune Function

目的:探讨右美托咪定复合瑞芬太尼用于肺癌切除术后的镇痛效果及对机体免疫功能的影响。方法:60例行肺癌切除术治疗的患者随机分为对照组(30例)和观察组(30例)。所有患者均于气管内插管全身麻醉下行肺癌切除术。术后,对照组患者给予盐酸瑞芬太尼10μg/(kg·d)+盐酸昂丹司琼注射液16 mg,加入0.9%氯化钠注射液中共配制成100 ml。观察组患者给予盐酸右美托咪定注射液0.75μg/(kg·d)+盐酸瑞芬太尼10μg/(kg·d)+盐酸昂丹司琼注射液16 mg,加入0.9%氯化钠注射液中共配制成100 ml。两组背景剂量均为2 ml/h,自控量为2 ml,锁定时间为15 min。观察两组患者术后6、12、24、48 h的视觉疼痛模拟(VAS)评分、γ干扰素(IFN-γ)、白细胞介素(IL)-10水平、T细胞亚群(CD3^+、CD4^+、CD8^+、CD4^+/CD8^+)水平及不良反应发生情况。结果:观察组患者术后6、12、24、48 h的VAS评分均显著低于对照组同期,且两组患者术后24、48 h的VAS评分均显著低于同组术后6 h,差异均有统计学意义(P<0.05)。观察组患者术后6、12、24、48 h的IFN-γ水平均显著低于对照组同期,且两组患者术后12、24、48 h均显著低于同组术后6 h,观察组患者术后12、24、48 h的IL-10水平均显著高于同组术后6 h及对照组同期,差异均有统计学意义(P<0.05)。观察组患者术后6、24、48 h的CD3^+,术后6、12、48 h的CD4^+,术后12、24、48 h的CD4^+/CD8^+水平均显著高于对照组同期,术后12、24 h的CD8^+水平均显著低于对照组同期;两组患者术后12、24、48 h的CD3^+、CD4^+及对照组患者的CD4^+/CD8^+,观察组患者术后12、24 h和对照组患者术后24 h的CD8^+水平均显著低于同组术后6 h,差异均有统计学意义(P<0.05)。两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论:右美托咪定复合瑞芬太尼用于肺癌切除术后的镇痛效果优于单用瑞芬太尼,可改善患者免疫功能,且安全性较好。

OBJECTIVE：To investigate the postoperative analgesic effect of Dexmedetomidine combined with Remifentanil on patients in lung cancer resection and its effect on immune function. METHODS：60 lung cancer patients in lung cancer resection were randomly divided into control group（30 cases）and observation group（30 cases）. All patients with endotracheal intubation received lung cancer resection under general anesthesia. After surgery,control group received Remifentanil hydrochloride 10 μg/（kg·d）＋Ondansetron hydrochloride injection 16 mg,adding into 0.9% Sodium chloride injection co-formulated into 100 ml;observation group received Dexmedetomidine hydrochloride injection 0.75 μg/（kg·d）＋Remifentanil hydrochloride 10 μg/（kg·d）＋Ondansetron hydrochloride injection 16 mg,adding into 0.9% Sodium chloride injection co-formulated into 100 ml. Background doses in 2groups were 2 ml/h,self-controlled amount was 2 ml,lockout time was 15 min. Visual analog pain score（VAS）,IFN-γ,IL-10 level,T cell subsets（CD3-＋,CD4-＋,CD8-＋,CD4-＋/CD8-＋）after 6,12,24,48 h and the incidence of adverse reactions in 2 groups were observed. RESULTS：VAS scores after 6,12,24,48 h in observation group were significantly lower than control group,and VAS scores after 24,48 h in 2 groups were significantly lower than that after 6 h,with statistical significance（P〈0.05）. IFN-γ levels after 6,12,24,48 h in observation group were significantly lower than control group,and IFN-γ levels after 12,24,48 h in 2groups were significantly lower than that after 6 h,IL-10 level after 12,24,48 h in observation group were significantly higher than that 6 h and control group,with statistical significance（P〈0.05）. CD3-＋after 6,24,48 h,CD4-＋after 6,12,48 h,CD4-＋/CD8-＋after 12,24,48 h in observation group were significantly higher than control group,CD8-＋after 12,24 h were significantly lower than control group,CD3-＋,CD4-＋after 12,24,48 h in 2 groups,CD4-＋/CD8-＋in control group,and CD8-＋after 12,24 h in observation group and after 24 h in control group were significantly lower than that after 6 h,with statistical significance（P〈0.05）. There was no significant difference in the incidence of adverse reactions in 2 groups（P〈0.05）. CONCLUSIONS：The postoperative analgesic effect of Dexmedetomidine combined with Remifentanil on patients in lung cancer resection is superior to Remifentanil alone,it can improve the immune function,with good safety.