羟考酮、舒芬太尼和芬太尼用于术后镇痛对结肠癌患者免疫功能的影响

Effects of oxycodone,sufentanil and fentanyl on immune function in patients with colon cancer under postoperative analgesia

目的比较羟考酮、舒芬太尼和芬太尼在术后镇痛对结肠癌患者免疫功能的影响。方法择期行结肠癌根治术患者90例,男49例,女41例,年龄<65岁,ASAⅠ或Ⅱ级,采用随机数字表法将患者随机均分为三组:羟考酮组(O组)、舒芬太尼组(SF组)和芬太尼组(F组),术中均采用同一种方式维持麻醉,术毕静脉连接镇痛泵。配方:O组:羟考酮2mg/kg+格拉司琼3mg,添加生理盐水至100ml;SF组:舒芬太尼0.002mg/kg+格拉司琼3mg,添加生理盐水至100ml;F组:芬太尼0.02mg/kg+格拉司琼3mg,添加生理盐水至100ml。PCIA泵背景量为2ml/h,每次按压量为2ml,锁定时间为15min,泵注时间持续24h,术后随访2d。记录术毕时、术后6、12、24、48h静脉血CD4^+、CD8^+及NK细胞的百分比。结果术后6、12、24hO组CD4^+和CD8^+ T细胞百分比明显高于SF组和F组(P<0.05);术后6hF组CD8+ T细胞百分比明显高于SF组(P<0.05);术后12、24、48hO组NK细胞百分比明显高于SF组和F组(P<0.05)。结论三种镇痛药物均不同程度地引起免疫功能的降低,舒芬太尼和芬太尼对免疫功能的影响相当,但羟考酮对免疫功能的影响相对较小,是结肠癌患者术后比较合适的镇痛药物。

Ojective To compare the effect of oxycodone, sufentanil and fentanyl on immune function in patients with colon cancer under postoperative analgesia, provide guidance and basis for clinical medication. Methods Ninety patients 49 males and 41 females, aged 〈65 years, ASA physical status Ⅰ or Ⅱ, were enrolled and randomly divided into 3 groups using a random number table （n=30）： oxycodone group （group O）, sufentanil group （group SF）and fentanyl group （group F）. All patients underwent the same way to maintain anesthesia. The PCIA pump recipe were as follows： group O, oxycodone 2 mg/kg＋granisetron 3 mg, added normal saline to 100 ml; group SF, sufentanil 0.002 mg/kg＋granisetron 3 mg, added normal saline to 100 ml; group F, fentanyl 0.02 mg/kg＋granisetron 3 mg, added normal saline to 100 ml;The background volume of PCIA electronic pump was 2 ml/h, the amount of each press was 2 ml, the lock time was 15 min, the pump time lasted for 24 h and maintained for 2 days after operation. The percentage of CD4^＋, CD8^＋and NK cells in venous blood were recorded at the end of surgery, 6 h, 12 h, 24 h and 48 h after surgery. Results In CD4＋, in the time points of 6 h, 12 h, 24 h after surgery, it was significantly higher in group O than that in groups SF and F （P〈0.05）; CD8＋ in group O was higher than that of group F, and CD8＋ in group F was higher than group SF at the time of 6 h after surgery. The group O was significantly higher than that of the groups SF and F at the times of 12 h, 24 h after surgery （P〈0.05）; In NK cells, at the time points of 12 h, 24 h and 48 h after surgery, it was significantly higher in group O than in groups SF and F （P〈0.05）. Conclusion Three analgesic drugs caused decline in immune function. Sufentanil and fentanyl have the similar effects on immunity, but oxycodone have a relatively small effect on immunity. Oxycodone is a more appropriate analgesic drug for colon cancer under postoperative analgesia.