右美托咪定复合舒芬太尼对结肠癌根治术后镇痛及免疫功能与应激反应的影响

Effects of dexmedetomidine combined with sufentanil on analgesia,immune function and stress reaction of patients after radical resection of colon cancer

目的探究右美托咪定复合舒芬太尼对结肠癌根治术后镇痛及免疫功能与应激反应的影响。方法选择2016年7月—2018年7月我院收治的行结肠癌根治术的患者96例为研究对象,按照随机数表法分成对照组(n=48)和观察组(n=48)。两组患者手术麻醉方式相同,术后镇痛对照组采用1.0μg·kg^(-1)·d^(-1)舒芬太尼+8.0 mg托烷司琼;观察组采用1.5μg·kg^(-1)·d^(-1)右美托咪定+1.0μg·kg^(-1)·h^(-1)舒芬太尼^(+)8.0 mg托烷司琼;两组患者均采用自控镇痛。分别评价两组患者术后0 h(T1)、4 h(T2)、8 h(T3)、24 h(T4)的镇痛效果(VAS及Ramsay评分)、免疫功能水平(IgG、IgA、IgM、CD4^(+)及CD8^(+)T细胞)、应激水平[促肾上腺皮质激素(ACTH)、皮质醇(Cor)、醛固酮(ALD)]、血清S-100β及神经元特异性烯醇化酶(NSE)水平、不良反应的发生情况。结果两组患者镇痛效果存在明显差异,同时间点观察组VAS评分明显低于对照组(P<0.05),Ramsay评分明显高于对照组(P<0.05);免疫功能与应激反应方面,T4时间点观察组患者免疫功能指标IgG、IgA、IgM、CD4^(+)T细胞水平均明显高于对照组(P<0.05),CD8^(+)T细胞水平显著低于对照组(P<0.05),应激指标ACTH、Cor及ALD水平均明显低于对照组(P<0.05);T1时间点两组患者血清S-100β、NSE水平均无明显差异(P>0.05),T4时间点观察组血清S-100β、NSE水平均明显低于对照组(P<0.05);药物安全性方面,观察组恶心呕吐的发生率明显低于对照组(6.25%vs.20.83%,P<0.05),心动过缓的发生率明显高于对照组(20.83%vs.6.25%,P<0.05)。结论右美托咪定复合舒芬太尼对结肠癌患者的术后镇痛效果好,可增强免疫功能,减轻应激反应,降低血清S-100β、NSE水平。

Objective To explore the effects of dexmedetomidine combined with sufentanil on the analgesic effect,immune function and stress response of patients after radical resection of colon cancer.Methods A total of 96 patients who underwent radical resection of colon cancer in our hospital between July 2016 and July 2018 were randomly divided into observation group(n=48)and control group(n=48).Patients in the two groups were given the same operating anesthesia,and all had self-controlled analgesia.The patients in control group were given 1.0μg·kg^(-1)·d^(-1)sufentanil +8.0 mg tropisetron,and those in observation group were given 1.5μg·kg^(-1)·d^(-1) dexmedetomidine +1.0μg·kg^(-1)·d^(-1)sufentanil +8.0 mg tropisetron.The changes of analgesic effect(VAS and Ramsay scores),immune function(levels of IgG,IgA,IgM,CD4^(+) and CD8^(+)),stress level[adrenocorticotropic hormone(ACTH),hydrocortisone(Cor)and aldosterone(ALD)],serum levels of S-100β and neuron-specific enolase(NSE),and adverse reactions of the two groups were evaluated at 0 h(T1),4 h(T2),8 h(T3),24 h(T4)after operation.Results There were significant differences in analgesic effect between the two groups.The VAS scores of the observation group at T2,T3 and T4 were respectively lower than those of the control group(P<0.05).The Ramsay scores of the observation group at T2,T3 and T4 were respectively higher than those of the control group(P<0.05).At T4 time point,the levels of IgG,IgA,IgM,CD4^(+)T cells of the observation group were significantly higher than those of the control group(P<0.05),while the CD8^(+) level of the observation group were significantly lower than that of the control group(P<0.05).The levels of ACTH,Cor and ALD were significantly lower in the observation group than in the control group(P<0.05).There were no significant differences in the serum levels of S-100βand NSE at T1 between the two groups(P>0.05).At T4,the serum levels of S-100βand NSE were significantly lower in the observation group than in the control group(P<0.05).As for drug safety,the incidence of nausea and vomiting in the observation group was significantly lower than that in the control group(6.25%vs.20.83%,P<0.05),and the incidence of bradycardia in the observation group was significantly higher than that in the control group(20.83%vs.6.25%,P<0.05).Conclusion Dexmedetomidine combined with sufentanil has better analgesic effect on patients with radical resection of colon cancer.It can enhance the immune function,alleviate stress response and reduce serum S-100βand NSE levels of patients after colon cancer operation.