地佐辛与芬太尼对老年胃癌根治术患者应激和免疫功能的影响

Comparison of stress response and immune function during postoperative analgesia with dezocine versus fentanyl in elderly gastric cancer patients with radical surgery

目的比较地佐辛与芬太尼对老年胃癌根治术患者应激和免疫功能的影响。方法选取2014年1月至2017年1月新疆维吾尔自治区人民医院收治的择期行胃癌根治术的老年患者210例为研究对象,根据患者术后给予不同的镇痛药物分为芬太尼组(105例)和地佐辛组(105例)。术中均采用全凭静脉麻醉,术毕给予患者静脉自控镇痛(PCIA)。芬太尼组采用PCIA配方:芬太尼0.01mg/kg复合托烷司琼6mg;地佐辛组采用PCIA配方:地佐辛0.8mg/kg复合托烷司琼6mg。分别于术前(T1)、手术结束即刻(T2)、术后24h(T3)、术后48h(T4)各时间点抽取静脉血,采用酶联免疫吸附试验(ELISA)检测血浆肾上腺素、去甲肾上腺素、皮质醇浓度,采用流式细胞仪检测T淋巴细胞亚群和NK细胞水平,记录术后不良反应发生情况。结果与T1时比较,两组患者T3、T4时血糖、皮质醇、血浆肾上腺素及去甲肾上腺素水平明显升高,但地佐辛组升高水平明显低于芬太尼组(P<0.05);与T1比较,两组患者T2、T3和T4时点CD3+、CD4+、CD4+/CD8+和NK水平均明显降低,其中,芬太尼组上述指标较地佐辛组降低更明显(P<0.05);两组患者术后不良反应发生率比较,差异无统计学意义(P>0.05)。结论与芬太尼术后镇痛效果比较,地佐辛可有效减轻老年胃癌根治术患者术后应激反应,改善机体细胞免疫功能,值得临床推广。

Objective To investigate the effect of dezocine versus fentanyl on stress response and immune function during postoperative analgesia in elderly gastric cancer patients with radical surgery.Methods A total of 210 elderly patients with gastric cancer undergoing radical operation in Xinjiang Uygur Autonomous Region People′s hospital from January 2015 to January 2017 were enrolled in the study.The patients were divided into fentanyl group（105 cases）and dezocine group（105 cases）.Total intravenous anesthesia was used during the operation,and the patient-controlled intravenous analgesia（PCIA）was used for postoperative analgesia.PCIA solution contained fentanyl（0.01 mg/kg）and tropisetron（6 mg）in fentanyl group;the dezocine（0.8 mg/kg）and tropisetron（6 mg）for PCIA in dezocine group.The levels of adrenaline,norepinephrine,cortisol were measured by enzyme-linked immunosorbent assay（ELISA）at preoperative（T1）,immediate after operation（T2）,24 h（T3）and 48 h（T4）after operation.The levels of T lymphocyte subsets and NK cell levels were measured by flow cytometry.The rates of adverse reactions after surgery were recorded.Results Compared with T1,the levels of blood glucose,cortisol,plasma adrenaline and norepinephrine were significantly increased in T3 and T4 in two groups,the above indexes at T3 and T4 were significantly lower in the dezocine group than the fentanyl group（P〈0.05）.Compared with T1,the levels of CD3＋,CD4＋,CD4＋/CD8＋and NK were significant decreased at T3 and T4 in both groups（P〈0.05）,but the above indexes were significantly lower in the fentanyl group than those in the the dezocine group（P〈0.05）.There was no significant difference in the incidence rates of adverse reactions between two groups（P〈0.05）.Conclusion Compared with fentanyl,dezocine can relieve postoperative pain better for elderly patients with gastric cancer undergoing radical surgery,and reduce the postoperative stress response and improve immune function,which is worthy of clinical application.