对比观察芬太尼与地佐辛对老年乳腺癌术后患者镇痛效果、应激反应、炎症因子及细胞免疫的影响

Comparative observation of the effects of fentanyl and dezocine on the analgesic effect,stress response,inflammatory factors and cellular immunity in elderly patients with breast cancer after surgery

目的比较芬太尼与地佐辛对老年乳腺癌患者术后镇痛效果、应激反应、炎症因子及细胞免疫的影响。方法选取2018年12月-2019年12月于东部战区空军医院麻醉科行乳腺癌根治术的120例老年患者,按随机盲法设为试验组(n=60)和对照组(n=60),试验组给予地佐辛治疗,对照组给予芬太尼治疗。观察并比较2组术后各时间点视觉模拟评分(VAS)、应激反应、炎症因子及免疫细胞水平。结果试验组患者术后4 h、12 h、24 h、48 h VAS评分低于对照组(P<0.05)。试验组患者术后12 h、24 h血浆醛固酮、皮质醇、肾素、血管紧张素II低于对照组(P<0.05)。2组患者在T1、T2时NK细胞和T细胞亚群水平较T0时均降低(P<0.05)。试验组患者在T1、T2时NK细胞、T淋巴细胞亚群指标以及白介素(IL)-2水平高于对照组(P<0.05),在T2时,试验组患者IL-10水平低于对照组(P<0.05)。结论老年乳腺癌患者根治术后应用地佐辛可有效缓解疼痛,减轻应激反应,调节炎症因子和免疫细胞的水平,促进免疫功能的恢复。

Objective To compare the effects of fentanyl and dezocine on postoperative analgesia,stress response,inflammatory factors and cellular immunity in elderly patients with breast cancer after surgery.Methods A total of 120 elderly patients with breast cancer who underwent radical mastectomy in the department of anesthesiology of Eastern Theater Air Force Hospital from December 2018 to December 2019 were selected and divided into the experimental group(n=60)and the control group(n=60)according to the random blind method.The experimental group was treated with dezocine,while the control group was treated with fentanyl.Visual analogue scale(VAS),stress response,inflammatory factors and immune cell levels at each time point after operation were observed and compared between the two groups.Results The VAS scores of the observation group were lower than those of the control group at 4 h,12 h,24 h,and 48 h after operation(P<0.05).Plasma aldosterone,cortisol,renin,and angiotensin II of the observation group were lower than those of the control group at 12 h and 24 h after operation(P<0.05).The levels of NK cells and T cell subsets at T1 and T2 were lower than those at T0 in the two groups(P<0.05).The levels of NK cells,T lymphocyte subsets and interleukin(IL)-2 of the observation group were higher than those of the control group at T1 and T2(P<0.05),but the IL-10 level of the observation group were lower than that of the control group at T2(P<0.05).Conclusion Dezocine can effectively relieve pain,reduce stress response,regulate the level of inflammatory factors and immune cells,and promote the recovery of immune function in elderly patients with breast cancer after radical surgery.