不同剂量羟考酮复合右美托咪定麻醉对肺癌根治术患者自控静脉镇痛效应及免疫应答的影响

Effects of Different Doses of Oxycodone Combined with Dexmedetomidine Anesthesia on Patient-Controlled Intravenous Analgesia and Immune Response in Patients Undergoing Radical Resection of Lung Cancer

目的:观察不同剂量羟考酮复合右美托咪定麻醉在肺癌根治术患者中的临床应用效果。方法:采用随机数字表法,将2017年3月~2020年12月期间在我院行肺癌根治术的肺癌患者(n=140)分为A组(1.0 mg/kg羟考酮)、B组(2.5μg/kg右美托咪定、1.0mg/kg羟考酮)、C组(2.5μg/kg右美托咪定、0.75 mg/kg羟考酮)、D组(2.5μg/kg右美托咪定、0.5 mg/kg羟考酮),各为35例。观察四组患者的血流动力学、免疫应答、镇痛效应满意度及不良反应发生率。结果:C组、D组术后2 h(T1)~术后6 h(T2)时间点心率(HR)、平均动脉压(MAP)小于A组、B组(P<0.05)。而A组、B组之间和C组、D组之间的T1、T2时间点HR、MAP组间对比差异不显著(P>0.05)。A组、D组的镇痛效应满意度小于C组和B组(P<0.05)。而A组、D组之间和C组、B组之间的镇痛效应满意度组间对比无差异(P>0.05)。C组、D组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于A组、B组;CD8^(+)则低于A组、B组(P<0.05)。而C组、D组之间、A组、B组之间的CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)组间对比差异不显著(P>0.05)。C组的不良反应发生率小于A组、B组、D组(P<0.05)。结论:羟考酮复合右美托咪定麻醉用于肺癌根治术患者,以0.75 mg/kg羟考酮+2.5μg/kg右美托咪定的效果最好,可获得较好的镇痛效应满意度,稳定血流动力学,减轻免疫抑制,安全可靠。

Objective:To observe the clinical effect of different doses of oxycodone combined with dexmedetomidine anesthesia in patients undergoing radical resection of lung cancer.Methods:Used the random number table method,patients with lung cancer(n=140)who underwent radical resection of lung cancer in our hospital from March 2017 to December 2020 were divided into group A(1.0 mg/kg oxycodone)and group B(2.5μg/kg dexmedetomidine,1.0 mg/kg oxycodone),group C(2.5μg/kg dexmedetomidine,0.75 mg/kg oxycodone),group D(2.5μg/kg dexmedetomidine,0.5 mg/kg oxycodone),35 cases in each.Hemodynamics,immune response,satisfaction of analgesic effect and incidence of adverse reactions were observed in the four groups.Results:The heart rate(HR)and mean arterial pressure(MAP)at 2 h after operation(T1)to 6 h after operation(T2)time points in the group C and group D were lower than those in the group A and group B(P<0.05).There were no significant differences in HR and MAP at T1 and T2 time points between the between group A and group B,group C and group D(P>0.05).The satisfaction of analgesic effect in the group A and group D was lower than that in the group C and group B(P<0.05).There were no significant differences in the satisfaction of analgesic effect between the between the group A and group D,group C and group B(P>0.05).CD3^(+),CD4t,CD4^(+)/CD8^(+)in group C and group D were higher than those in group A and group B.CD8^(+)was lower than that in the group A and group B(P<0.05).There were no significant differences in CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)between the group C and group D,between the group A and group B(P>0.05).The incidence of adverse reactions in the group C was lower than that in the group A,group B and group D(P<0.05).Conclusion:Oxycodone combined with dexmedetomidine anesthesia is used in patients undergoing radical resection of lung cancer with 0.75 mg/kg oxycodone combined with 2.5μg/kg dexmedetomidine has the best effect,can obtain better satisfaction with analgesic effect,stabilize hemodynamics,reduce immunosuppression,and which is safe and reliable.