右美托咪定联合舒芬太尼术后镇痛对老年肺癌患者T细胞亚群、血清炎性因子和疼痛介质指标的影响

Effects of Dexmedetomidine Combined with Sufentanil for Postoperative Analgesia on T Cell Subsets,Serum Inflammatory Factors and Pain Mediators in Elderly Patients with Lung Cancer

目的:观察右美托咪定联合舒芬太尼术后镇痛对老年肺癌患者T细胞亚群、血清炎性因子和疼痛介质指标的影响。方法:选取2017年7月~2020年12月期间200例我院收治的行肺癌根治术的老年患者,按随机数字表法分为研究组(n=100)、对照组(n=100)。对照组术后镇痛选用舒芬太尼,研究组术后镇痛选用右美托咪定联合舒芬太尼,观察两组患者视觉模拟评分法(VAS)评分和Ramsay镇静评分、外周血T细胞亚群、血清炎性因子和疼痛介质指标、不良反应。结果:两组术后6 h、12 h、24 h、48 h的Ramsay镇静评分、VAS评分均较术后1 h下降(P<0.05),且研究组以上时间点Ramsay镇静评分高于对照组,而VAS评分低于对照组(P<0.05)。两组术后24 h血清干扰素-γ(IFN-γ)、白细胞介素-6(IL-6)升高,但研究组术后24 h血清IFN-γ、IL-6低于对照组(P<0.05)。两组术后24 h外周血CD8^(+)升高,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)降低(P<0.05),但术后24 h研究组CD8^(+)低于对照组,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于对照组(P<0.05)。术后24 h两组血清β-内啡肽(β-EP)、P物质(SP)以及一氧化氮(NO)水平均升高,但研究组低于对照组(P<0.05)。两组不良反应发生率组间对比无统计学差异(P>0.05)。结论:右美托咪定联合舒芬太尼用于老年肺癌患者术后镇痛,镇痛、镇静效果确切,同时可减轻免疫抑制及炎性反应,且安全性高。

Objective:To observe the effects of dexmedetomidine combined with sufentanil for postoperative analgesia on T cell subsets,serum inflammatory factors and pain mediators in elderly patients with lung cancer.Methods:200 cases patients who underwent radical resection of lung cancer in our hospital were selected from July 2017 to December 2020.According to the random digital table method,the patients were divided into study group(n=100)and control group(n=100).The control group used sufentanil for postoperative analgesia,and the study group used dexmedetomidine combined with sufentanil for postoperative analgesia.Visual Analogue Scale(VAS)and Ramsay Sedation score,peripheral blood T cell subsets,serum inflammatory factors,pain mediators index and adverse reactions in the two groups were observed.Results:The Ramsay Sedation and VAS scores at 6 h,12 h,24 h and 48 h after operation in the two groups were lower than those at 1 h after operation(P<0.05),the Ramsay Sedation scores was higher than that of the control group at the above time points,while the VAS score of the study group was lower than that of the control group(P<0.05).The levels of serum interferon-γ(IFN-γ)and interleukin-6(IL-6)in the two groups at 24 h after operation increased,but the IFN-γand IL-6 in the study group were lower than those in the control group 24 h after operation(P<0.05).The CD8^(+)increased and CD3^(+),CD4^(+),CD4^(+)/CD8^(+)decreased in the two groups at 24 h after operation(P<0.05),but CD8^(+)was lower than that of the control group,and the CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in the study group were higher than those in the control group at 24 h after operation(P<0.05).The levels of serumβ-endorphin(β-EP),substance P(SP)and nitric oxide(NO)were increased in the two groups at 24 h after operation,but the study group was lower than 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:Dexmedetomidine combined with sufentanil for postoperative analgesia in elderly patients with lung cancer has significant analgesic and sedative effect,and can reduce immunosuppression and inflammatory reaction,with high safety.