舒芬太尼靶控镇痛对腹腔镜手术患者应激反应、免疫功能的影响

Effect of target-controlled infusion of sufentanil on the postoperative stress response and immune function of patients with laparoscopic surgery

目的探讨舒芬太尼靶控镇痛对腹腔镜手术患者术后应激反应、免疫功能的影响。方法选取下腹部恶性肿瘤患者40例,随机分为观察组和对照组各20例。观察组行静脉靶控镇痛,对照组行传统静脉镇痛。比较2组患者术后视觉模拟评分(VAS)变化,以及麻醉诱导前(T_1)、诱导后0.5 h(T_2)、诱导后4 h(T_3)及术后1 d(T_4)的血清白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)和C-反应蛋白(CRP)水平以及外周血免疫细胞水平。结果观察者患者术后各个时间点的VAS评分显著低于对照组患者(P<0.05)。2组患者T_2、T_3和T_4的IL-6和IL-10较T_1升高,IL-2较T_1时降低,T_3、T_4的CRP较T_1时CRP升高,差异均有统计学意义(P<0.05)。观察组T_2、T_3和T_4的IL-6、IL-10低于对照组,IL-2高于对照组,T_3、T_4时CRP低于对照组,差异有统计学意义(P<0.05)。2组患者T_1时CD4^+、CD4^+/CD8^+相比无显著差异(P>0.05),T_2、T_3和T_4时观察组患者的CD4^+、CD4^+/CD8^+显著高于对照组患者(P<0.05)。2组不良反应均为恶心呕吐,且轻微,差异无统计学意义(P>0.05)。结论对于腹腔镜下腹部恶性肿瘤根治术患者,使用舒芬太尼靶向镇痛能够明显减轻术后应激反应,副作用较少,安全性较高。

Objective To investigate effect of target-controlled infusion of sufentanil on the postoperative stress response and immune function of patients with laparoscopic surgery. Methods A total of 40 cases with abdominal malignancies were equally divided into two groups. The observation group received intravenous target-controlled analgesia,while the control group received traditional intravenous analgesia. The changes of Visual Analogue Scale（ VAS）,serum interleukin-2（ IL-2）,serum interleukin-6（ IL-6）,serum interleukin-10（ IL-10）,C-reactive protein（ CRP） and peripheral blood immune cell levels of the two groups were detected at four time points,namely pre-induction（ T1）,at 0. 5 h of post-induction（ T2）,4 h of post-induction（ T3）,and on first day of postoperation（ T4）. Results The postoperative VAS scores of the observation group at all time points were lower than that of the control group（ P〈0. 05）. Compared with the indicators at T1,the IL-6 and IL-10 levels were increased in both groups,while IL-2 levels were decreased at T2,T3 and T4,and CRP levels were increased at T3 and T4（ P〈0. 05）. The observation group had lower IL-6,IL-10 levels at T2,T3,T4,while higher IL-2 than the control group,and CRP levels at T3,T4 were lower than the control group（ P〈0. 05）. The CD4^＋and CD4^＋/CD8^＋at T1 had no significant difference（ P〉0. 05）,and were higher at T2,T3 and T4 in the observation group than the control group（ P〈0. 05）.Adverse reactions includingnausea and vomiting were mild,and showed no significant difference in two groups（ P〉0. 0 5）. Conclusion Target-controlled infusion of sufentanil for laparoscopic radical resection,characterized by less adverse reactions and higher safety,can reduce postoperative stress response,so it is worthy of promotion.