羟考酮联合右美托咪定术后镇痛对腹腔镜下结肠癌根治术患者炎性因子、T细胞亚群和认知功能的影响

Effects of Oxycodone Combined with Dexmedetomidine on Inflammatory Factors, T Cell Subsets and Cognitive Function in Patients Undergoing Laparoscopic Radical Resection of Colon Cancer

目的:探讨羟考酮联合右美托咪定术后镇痛对腹腔镜下结肠癌根治术患者炎性因子、T细胞亚群和认知功能的影响。方法:选取我院于2013年1月~2019年12月期间收治的80例行腹腔镜下结肠癌根治术的患者,采用随机数字表法将患者分为A组和B组,各40例,A组给予舒芬太尼联合右美托咪定术后镇痛,B组给予羟考酮联合右美托咪定术后镇痛,对比两组围术期指标、炎性因子、T细胞亚群和认知功能。结果:B组自主呼吸恢复时间、定向力恢复时间、拔管时间短于A组,自控镇痛泵(PCA)总按压次数少于A组,PCA有效按压次数多于A组(P<0.05)。两组术前、术后1 d、术后3 d的白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平呈先升高后降低趋势(P<0.05),B组术后1 d、术后3 d的IL-6、CRP、TNF-α水平低于A组(P<0.05)。两组术前、术后1 d、术后3 d的CD3+、CD4+、CD4+/CD8+呈先降低后升高趋势,CD8+呈先升高后降低趋势(P<0.05),B组术后1 d、术后3d CD3+、CD4+、CD4+/CD8+高于A组,CD8+则低于A组(P<0.05)。两组术后1 d、2 d、3 d简易精神状态检查表(MMSE)评分呈升高趋势(P<0.05),B组术后1 d、2 d、3 d的MMSE评分高于A组(P<0.05)。结论:腹腔镜下结肠癌根治术患者采用羟考酮联合右美托咪定术后镇痛,可减轻患者炎性反应及免疫抑制,同时还可减轻其认知功能损伤,促进其术后恢复。

Objective:To investigate the effect of oxycodone combined with dexmedetomidine on inflammatory factors,T cell subsets and cognitive function in patients undergoing laparoscopic radical resection of colon cancer.Methods:80 patients undergoing laparoscopic radical resection of colon cancer in our hospital from January 2013 to December 2019 were selected,and randomly divided into group A and group B,with 40 cases in each group.Group A was given sufentanil combine dexmedetomidine for postoperative analgesia,and group B was given oxycodone combine dexmedetomidine for postoperative analgesia.The perioperative indexes,inflammatory factors,T cell subsets and cognitive function were compared between two groups.Results:The spontaneous breathing recovery time,the directional force recovery time and extubation time in group B were shorter than those in group A,the total pressing times of PCA was less than that in group A,and the effective pressing times of PCA was more than that in group A(P<0.05).The levels of interleukin-6(IL-6),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)were increased and then decreased in the two groups at before operation,1 d and 3 d after operation(P<0.05).The levels of IL-6,CRP and TNF-αin group B were lower than those in group A at 1 d and 3 d after operation(P<0.05).The levels of CD3+,CD4+,CD4+/CD8+were decreased and then increased in the two groups at before operation,1 d and 3 d after operation,and CD8+increased first and then decreased(P<0.05).CD3+,CD4+,CD4+/CD8+in group B were higher than those in group A at 1 d and 3 d after operation,while CD8+was lower than that in group A(P<0.05).The Mini Mental State Examination(MMSE)scores in two groups increased at 1 d,2 d and 3 d after operation(P<0.05),and the MMSE scores in group B were higher than those in group A at 1 d,2 d and 3 d after operation(P<0.05).Conclusion:Patients undergoing laparoscopic radical resection of colon cancer are treated with oxycodone combined with dexmedetomidine for postoperative analgesia,which can reduce inflammatory reaction and immunosuppression,at the same time,it can also reduce cognitive impairment and promote postoperative recovery of patients.