舒芬太尼联合地佐辛术后自控静脉镇痛对腹腔镜胃癌根治术患者疼痛应激和T细胞亚群的影响

Effects of Sufentanil Combined with Dezocine Postoperative Patient-Controlled Intravenous Analgesia on Pain Stress and T Cell Subsets in Patients Undergoing Laparoscopic Radical Gastrectomy

目的:观察舒芬太尼联合地佐辛术后自控静脉镇痛(PCIA)对腹腔镜胃癌根治术患者疼痛应激和T细胞亚群的影响。方法:选取2018年1月~2020年7月期间于我院行腹腔镜胃癌根治术的患者97例,采用双色球法将患者分为对照组(48例,舒芬太尼术后PCIA)和观察组(49例,舒芬太尼联合地佐辛术后PCIA)。观察两组患者术后2 h、4 h、8 h、12 h、24 h疼痛及镇静情况[视觉模拟评分法(VAS)评分、Ramsay评分]。观察两组术前、术后24 h的疼痛应激[β-内啡肽、前列腺素E2(PEG2)、P物质]和T细胞亚群相关指标的变化情况,记录两组镇痛期间不良反应发生情况。结果:观察组术后4 h、8 h、12 h、24 h VAS评分均低于对照组(P<0.05)。观察组术后4 h、8 h、12 h、24 h Ramsay评分均高于对照组(P<0.05)。术后24 h,观察组血清β-内啡肽、PEG2、P物质水平低于对照组(P<0.05)。术后24 h,观察组CD3;、CD4;、CD4;/CD8;高于对照组,CD8;低于对照组(P<0.05)。两组不良反应发生率对比无明显差异(P>0.05)。结论:舒芬太尼联合地佐辛术后PCIA应用于腹腔镜胃癌根治术患者,镇静镇痛效果较好,安全性较好,可进一步抑制疼痛应激,对患者的免疫功能予以保护。

Objective:To observe the effect of sufentanil combined with dezocine postoperative patient-controlled intravenous analgesia (PCIA) on pain stress and T cell subsets in patients undergoing laparoscopic radical gastrectomy.Methods:From January 2018to July 2020,97 patients undergoing laparoscopic radical gastrectomy in our hospital were selected,and they were divided into control group (48 cases,sufentanil postoperative PCIA) and observation group (49 cases,sufentanil combined with dezocine postoperative PCIA)by double color ball method.The pain and sedation[visual analogue scale (VAS) score,Ramsay score]at 2 h,4 h,8 h,12 h and 24 h after operation were observed in the two groups.The changes of pain stress[β-endorphin,prostaglandin E2 (PEG2),substance P]and T cell subsets related indicators before and 24h after operation were observed in the two groups.The incidence of adverse reactions during analgesia was recorded in the two groups.Results:VAS scores of observation group at 4 h,8 h,12 h and 24 h after operation were lower than that of control group (P<0.05).Ramsay scores of the observation group at 4 h,8 h,12 h and 24 h after operation were higher than that of the control group (P<0.05).24 h after operation,the levels of serumβ-endorphin,PEG2 and substance P of the observation group were lower than those of the control group (P<0.05).24 h after operation,CD3;,CD4;,CD4;/CD8;of the observation group were higher than those of the control group,and CD8;was lower than that of the control group (P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).Conclusion:The application of sufentanil combined with dezocine in postoperative PCIA in patients undergoing laparoscopic radical gastrectomy has good sedative and analgesic effects,and good safety,which can further inhibit pain stress,and protect the immune function of patients.