右美托咪定复合舒芬太尼术后镇痛对肺癌患者免疫功能及肺部并发症的影响

The efficacy of dexmedetomidine combined with sufentanil for postoperative analgesia and the effect on immune function and pulmonary complications in patients undergoing operation of lung cancer

目的 研究右美托咪定（dexmedetomidine， Dex）复合舒芬太尼用于肺癌术后患者静脉自控镇痛（patient-controlled intravenous analgesia， PCIA）对机体免疫功能和肺部并发症的影响。 方法 120例择期行胸腔镜下肺叶切除术的肺癌患者，采用随机数字表法分为Dex 3.0 μg/kg复合舒芬太尼1.6 μg/kg组（A组）和舒芬太尼3.0 μg/kg组（B组），每组60例，术毕两组分别行PCIA。观察两组镇痛、镇静效果并记录副作用及肺部并发症，于术前、术毕拔管时、术后24 h、术后48 h及术后1周、术后2周抽外周血检测自然杀伤（natural killer， NK）细胞数目、γ干扰素（interferon-γ， IFN-γ）、 IL-4水平和辅助性T细胞1/辅助性T细胞2（T helper cells 1/T helper cells 2， Th1/Th2）比率。 结果 术后两组镇痛（采用VAS）、镇静评分［采用警觉与镇静评分（observer＇s assessment of alertness/sedation， OAA/S）］及追加镇痛药次数比较，差异无统计学意义（P〉0.05）。B组发生皮肤瘙痒、术后恶心呕吐（postoperative nausea and vomiting， PONV）、肺水肿和肺部感染的例数分别为8、16、8、11例，A组分别为0、2、2、3例，两组差异有统计学意义（P〈0.05）。术毕拔管时、术后24 h和术后48 h两组NK细胞数目、IFN-γ和Th1/Th2比率显著降低，IL-4水平显著增加（P〈0.05）。术后1周A组NK细胞数目、IFN-γ、IL-4和Th1/Th2比率恢复至术前水平，但B组与术前比较差异仍有统计学意义（P〈0.05），B组于术后2周免疫参数恢复至术前水平。 结论 Dex复合舒芬太尼在胸腔镜下肺叶切除术后PCIA中应用不仅可以减少术后皮肤瘙痒、PONV和肺部并发症的发生率，还可以促进免疫功能的恢复。

Objective To evaluate the efficacy of patient-controlled intravenous analgesia（PCIA） using dexmedetomidine （Dex） combined with sufentanil and the effect on postoperative immune function and pulmonary complications in patients undergoing operation of lung cancer. Methods One hundred and twenty patients with lung cancer were recruited in this study, and randomly divided into two groups for PCIA after thoracoscopic lobectomy, group A（Dex and sufentanil group, n=60） and group B （sufentanil group, n=60）. VAS scores, observer＇s assessment of alertness/sedation（OAA/S） scores, and pulmonary complications were recorded after operation. And the number of natural killer （NK） cells, the level of interferon-γ （IFN-γ） or IL-4, and the ratio of T helper cells 1/T helper cells 2（Th1/Th2） were measured perioperation. Results There was no significant difference between the two groups in VAS, OAA/S scores and additional analgesics（P〉0.05）. The cases of pruritus, postoperative nausea and vomiting（PONV）, and pulmonary complications in group B were 8, 16, 8 and 11, while they were 0, 2, 2 and 3 in group A, respectively（P〈0.05）, and there were significantly difference between the two groups. The number of NK cells, IFN-γ level and radio of Th1/Th2 were significantly decreased, and IL-4 level was significantly increased in both groups as early as the end of surgery （P〈0.05）, and they all restored in 1 week after surgery in group A（P〉0.05）, however, in group B, they all restored in 2 weeks after surgery（P〉0.05）. Conclusions Dex combined with sufentanil is efficient for PCIA in patients undergoing thoracoscopic lobectomy, it could decrease the incidence of pruritus, PONV and pulmonary complications, and promote the recovery of immune function.