右美托咪定与地佐辛复合用药对乳腺癌根治术患者术后疼痛和免疫功能的影响

Combination of dexmedetomidine and dezocine in patients undergoing radical mastectomy Influence of postoperative pain and immune function

目的探究地佐辛与右美托咪定复合应用于乳腺癌根治术麻醉中对患者术后疼痛、免疫功能的影响。方法选取2018年1月至2020年10月本院收治的400例乳腺癌患者,按照数字随机法分为空白组、对照A组、对照B组和研究组,每组100例。对照组A组在手术结束前15 min应用地佐辛,对照组B组在麻醉诱导前应用右美托咪定,研究组在麻醉诱导前应用右美托咪定,手术结束前15 min前应用地佐辛,空白组手术结束前15 min应用0.9%氯化钠溶液。比较4组临床恢复效果、疼痛评分及免疫功能变化。结果4组自主呼吸恢复时间、苏醒时间、拔管时间比较差异均无统计学意义。研究组躁动评分低于空白组、对照A组、对照B组,差异有统计学意义(P<0.05)。术后24 h,研究组CD4^(+)、CD4^(+)/CD8^(+)均高于空白组、对照A组、对照B组,差异有统计学意义(P<0.05)。研究组CD8^(+)低于空白组、对照A组、对照B组,差异有统计学意义(P<0.05)。4组即刻拔管疼痛评分比较差异无统计学意义。拔管后30 min,研究组疼痛评分低于空白组、对照A组、对照B组,差异有统计学意义(P<0.05)。结论右美托咪定与地佐辛复合用药,可有效降低乳腺癌根治术患者术后躁动评分及疼痛评分,提高免疫功能,利于改善患者预后,值得临床推广运用。

Objective To explore the effects of combined application of dezocine and dexmedetomidine in anesthesia during radical mastectomy on patients'postoperative pain and immune function.Methods 400 breast cancer patients admitted to our hospital from January 2018 to October 2020 were selected and they were divided into blank group,control group A,control group B,and study group according to the numerical randomization method,with 100 cases in each group.The control group A was treated with dezocine 15 minutes before the end of the operation,the control group B was treated with dexmedetomidine before the induction of anesthesia,the study group was treated with dexmedetomidine before the induction of anesthesia,and 15 minutes before the end of the operation.Zoxin,0.9%sodium chloride solution was applied 15 minutes before the end of the operation in the blank group.The clinical recovery effect,pain score and immune function change among the 4 groups were compared.Results There was no statistically significant difference in the recovery time of spontaneous breathing,wake-up time,and extubation time among the four groups.The restlessness score of the study group was lower than that of the blank group,control group A,and control group B,and the difference was statistically significant(P<0.05).At 24 h after operation,CD4^(+)and CD4^(+)/CD8^(+)in the study group were higher than those in the blank group,control group A,and control group B,and the difference was statistically significant(P<0.05).The CD8^(+) of the study group was lower than that of the blank group,control group A,and control group B,and the difference was statistically significant(P<0.05).There was no significant difference in the pain scores of immediate extubation among the 4 groups.30 minutes after extubation,the pain score of the study group was lower than that of the blank group,control groupA,and control group B,and the difference was statistically significant(P<0.05).Conclusion The combination of dexmedetomidine and dezocine can effectively reduce the postoperative restlessness score of patients undergoing radical mastectomy and the pain score,which improves the immune function and is beneficial to the prognosis of patients.It is worthy of clinical application.