酮咯酸氨丁三醇预防性镇痛对肺癌手术患者免疫功能的影响

The effect of ketorolac tromethamine on preventive analgesia in the immune function of patients with lung cancer surgery

目的探讨酮咯酸氨丁三醇预防性镇痛对肺癌手术患者免疫功能的影响。方法选取2017年9月—2019年9月大连市第五人民医院肺癌手术患者172例,依据随机数字表分为预防组和全麻组,每组86例,全麻组给予全麻干预,预防组在此基础上给予酮咯酸氨丁三醇预防性镇痛干预,比较两组平均动脉压(MAP)、心率(HR)、视觉模拟评分法(VAS)、免疫球蛋白(IgA、IgG、IgM)、T淋巴细胞亚群(CD3^+、CD4^+、CD4^+/CD8^+)以及不良反应。结果预防组麻醉15 min后(T1)、组织切开时(T2)、肿瘤切除时(T3)的MAP、HR明显低于全麻组,差异有统计学意义(P<0.001);预防组术后IgA、IgG、IgM、CD3^+、CD4^+、CD4^+/CD8^+明显高于全麻组,差异有统计学意义(P<0.001);预防组术后4 h、24 h、48 h、72 h的VAS评分明显低于全麻组,差异有统计学意义(P<0.001);预防组和全麻组不良反应发生率差异无统计学意义(P<0.05)。结论酮咯酸氨丁三醇预防性镇痛可有效改善肺癌手术患者血流动力学波动及镇痛效果,有利于改善患者免疫功能,且安全性好,值得临床推广。

Objective The objective of this study was to investigate the effect of ketorolac tromethamine on preventive analgesia in the immune function of patients with lung cancer surgery.Methods A total of 172 patients with lung cancer surgery in our hospital from September 2017 to September 2019 were selected and divided into the prevention group and general anesthesia group according to the random number table.Each group had 86 cases.The general anesthesia group was given general anesthesia intervention.The prevention group was given ketorolac tromethamine as the preventive analgesia.On the basis,the mean arterial pressure(MAP),heart rate(HR),visual analogue scale(VAS),immune globulin(IgA,IgG,and IgM)and T lymphocyte subsets(CD3^+,CD4^+,and CD4^+/CD8^+)and adverse reaction were compared between the prevention and general anesthesia groups.Results The MAP and HR in the prevention group at 15 min after anesthesia(T1),tissue incision(T2),tumor resection(T3)were significantly lower than those in the general anesthesia group,the difference was statistically significant(P<0.001).The levels of IgA,IgG,IgM,CD3^+,CD4^+,and CD4^+/CD8^+in the prevention group after operation were significantly higher than those in the general anesthesia group,the difference was statistically significant(P<0.001).The VAS scores in the prevention group at 4 h,24 h,48 h and 72 h were significantly lower than that in the general anesthesia group,the difference was statistically significant(P<0.001).There was no significant difference in the incidence of adverse reactions between the prevention and general anesthesia groups(P>0.05).Conclusion Preventive analgesia with ketorolac tromethamine can effectively improve the hemodynamic fluctuations and analgesic effect on patients with lung cancer surgery,and it is beneficial to improve the immune function of patients.It has good safety and worth for further clinical application.