舒芬太尼联合地佐辛自控镇痛对经腹子宫切除术后患者应激反应、免疫功能和炎症因子的影响

Effects of Sufentanil Combined with Dezocine Controlled Analgesia on Stress Response,Immune Function and Inflammatory Factors in Patients after Abdominal Hysterectomy

目的:探讨舒芬太尼联合地佐辛自控镇痛对经腹子宫切除术后患者应激反应、免疫功能和炎症因子的影响。方法:选择2020年4月~2021年8月期间来我院接受经腹子宫切除术的患者78例。根据随机数字表法将患者分为对照组(接受舒芬太尼自控镇痛)和观察组(接受舒芬太尼联合地佐辛自控镇痛),各为39例。观察并对比两组镇静镇痛情况[视觉疼痛模拟(VAS)评分和Ramsay镇静评分]、应激反应[去甲肾上腺素(NE)、肾上腺素(E)和皮质醇(Cor)]、免疫功能[CD3^(+)、CD4^(+)、CD8^(+),计算CD4^(+)/CD8^(+)]和炎症因子[白介素-2(IL-2)、白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)],同时记录两种镇痛方案的安全性。结果:两组术后6 h、术后24 h、术后48 h VAS评分先升高后下降,其中观察组术后24 h、术后48 h VAS评分均低于对照组同一时点(P<0.05)。两组术后6 h、术后24 h、术后48 h Ramsay镇静评分不同时间点组内及组间对比,差异无统计学意义(P>0.05)。两组镇痛48 h后血清NE、E、Cor水平升高,但观察组镇痛48 h后血清NE、E、Cor水平低于对照组同一时间点(P<0.05)。两组镇痛48 h后血清IL-2、IL-6、CRP、TNF-α水平升高,但观察组镇痛48 h后血清IL-2、IL-6、CRP、TNF-α水平低于对照组同一时间点(P<0.05)。两组镇痛48 h后CD8^(+)升高,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)下降,但观察组的变化幅度小于对照组(P<0.05)。两组不良反应发生率对比无统计学差异(P>0.05)。结论:经腹子宫切除术后患者采用舒芬太尼联合地佐辛自控镇痛,镇静、镇痛作用显著,同时还可减轻机体炎性损伤和应激反应,促进免疫功能恢复。

Objective:To investigate the effects of sufentanil combined with dezocine controlled analgesia on stress response,immune function and inflammatory factors in patients after abdominal hysterectomy.Methods:78 cases of patients who underwent abdominal hysterectomy in our hospital from April 2020 to August 2021 were selected.The patients were divided into control group(received sufentanil controlled analgesia)and observation group(sufentanil combined with dizocine controlled analgesia)according to the random number table method,with 39 cases in each group.The sedation and analgesia situation[visual pain simulation(VAS)score and Ramsay sedation score],stress response[norepinephrine(NE),epinephrine(E)and cortisol(Cor)],immune function[CD3^(+),CD4^(+),CD8^(+),calculate CD4^(+)/CD8^(+)]and inflammatory factors[interleukin-2(IL-2),interleukin-6(IL-6),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)]were observed and compared between the two groups.The safety of the two anesthesia regimens was recorded at the same time.Results:The VAS scores of the two groups increased first and then decreased at 6 h,24 h and 48 h after operation,and the VAS scores of the observation group at 24 h and 48 h after operation were lower than those of the control group at the same time point(P<0.05).There was no significant difference between the two groups at different time points of Ramsay Sedation score at 6 h,24 h and 48 h after operation(P>0.05).The levels of serum NE,E and Cor in the two groups increased at 48 h after analgesia,but the levels of serum NE,E and Cor of the observation group were lower than those of the control group at the same time point(P<0.05).The levels of serum IL-2,IL-6,CRP and TNF-αin the two groups at 48 h after analgesia increased,but the levels of serum IL-2,IL-6,CRP and TNF-αof the observation group at 48 h after analgesia were lower than those of the control group at the same time point(P<0.05).48 h after analgesia,CD8^(+)increased,and CD3^(+),CD4^(+),CD4^(+)/CD8^(+)decreased in the two groups,but the change range of the observation group was less 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:Sufentanil combined with dizocine for patient-controlled analgesia after transabdominal hysterectomy has significant sedative and analgesic effects.At the same time,it can also reduce inflammatory injury and stress reaction and promote the recovery of immune function.