纳布啡与羟考酮自控镇痛对非小细胞肺癌患者术后免疫因子水平影响的比较

Comparison between nalbuphine and oxycodone applied for patient controlled analgesia on postoperative immunological factor levels in patients with non-small cell lung cancer

目的比较纳布啡与羟考酮自控静脉镇痛(Patient controlled intravenous analgesia,PCIA)对非小细胞肺癌患者术后免疫因子水平的影响。方法选择我院择期行胸腔镜肺叶切除术的非小细胞肺癌患者80例,分为纳布啡组(N组)和羟考酮组(O组)。术后给予PCIA镇痛,配置方法:N组为1 mg/kg纳布啡+10 mg托烷司琼,O组为羟考酮20 mg+10 mg托烷司琼,均用生理盐水稀释至150 m L。分别在术前30 min(T0)、术后4 h(T_1)、8 h(T_2)、12 h(T_3)、24 h(T_4)时抽取外周静脉血5 m L,用于测定血清Ig G、Ig M、Ig A、TGF-β1、VEGF及IL-17水平,并计数CD4+、CD8+T细胞、NK细胞及CD4+/CD8+比值;分别在T_1、T_2、T_3、T_4时对所有患者进行VAS评分。结果两组患者术后各时间点VAS评分、PCIA泵有效按压次数及总消耗量均无统计学差异(P>0.05);与O组比较,N组血清Ig G水平在T_1~T_4,Ig M、Ig A水平则在T_2~T_4时要明显更高,而TGF-β1及VEGF水平在T_2~T_4,IL-17水平在T_1~T_4时要更低,CD4+T、NK细胞及CD4+/CD8+比值在T_2~T_4要更高,而CD8+T细胞则在T_1~T_4时要更高,差异均有统计学意义(P<0.05)。结论纳布啡用于非小细胞肺癌患者行胸腔镜肺叶切除术后PCIA能够有效控制术后疼痛,能够增加机体免疫球蛋白及免疫细胞水平,降低肿瘤免疫抑制因子水平,减轻围术期免疫抑制程度,改善机体免疫功能。

Objective The aim of this study was to compare the effects of morphine and oxycodone controlled intravenous analgesia（ PCIA） on postoperative immunological factor levels in patients with non-small cell lung cancer（ NSCLC）. Methods Eighty patients with NSCLC who underwent video-assisted thoracic surgical（ VATS） lobectomy were enrolled in the study. They were randomly divided into nalbuphine（ N group） and oxycodone group（ O group）. All patients were given PCIA analgesia after operation.Patients in the N group received nalbuphine hydrochloride at dose of 1. 0 mg/kg plus 10 mg of tropisetron for PCIA,while patients in the O group received oxycodone hydrochloride 20 mg plus 10 mg of tropisetron,all diluted to 150 m L with physiological saline. Five m L of peripheral venous blood was drawn at 30 min（ T0） before surgery and after surgery for 4（ T1）,8（ T2）,12（ T3） and 24 h（ T4） to determine serum levels of Ig G,Ig M,Ig A,TGF-β1,VEGF and IL-17,count the cell number of CD4＋T,CD8＋T and NK and calculate the ratio of CD4＋/CD8＋. VAS scores were performed on all patients at T1,T2,T3 and T4. Results There were no significant differences in the VAS scores,PCIA pump effective compressions and total consumption of PCIA between the N and O groups（ P〈0. 05）. Compared to the O group,the serum level of Ig G at T1- T4,Ig M and Ig A serum levels at T2- T4 were high in the N group; serum levels of TGF-β1 and VEGF at T2- T4 and IL-17 serum level at T1- T4 were low in the N group; the number of CD4＋T and NK cells,the ratio of CD4＋/CD8＋at T2- T4 and the number of CD8＋T at T1- T4 were high in the N group. The differences were statistically significant（ P〈0. 05）. Conclusion Nalbuphine for patients with NSCLC applied for PCIA after VATS lobectomy can effectively control postoperative pain,significantly increase levels of immunoglobulin and immune cells,reduce the level of tumor immunosuppressive factors,reduce perioperative immunosuppression degree,and improve the body＇s immune function.