纳布啡联合舒芬太尼PCIA对腹腔镜直肠癌根治术患者镇痛效果和免疫功能的影响

Effect of nalbuphine combined with sufentanil PCIA on analgesic effect and immune function in patients undergoing laparoscopic radical resection of rectal cancer

目的:探讨纳布啡联合舒芬太尼自控静脉镇痛(PCIA)对腹腔镜直肠癌根治术患者镇痛效果和免疫功能的影响。方法:选取102例择期行腹腔镜直肠癌根治术患者为研究对象,根据术后镇痛方法不同分为对照组与观察组,每组各51例。两组患者均予以相同的麻醉诱导及维持麻醉,术后均连接PCIA泵,其中对照组患者镇痛药液为舒芬太尼2.0μg/kg+阿扎司琼10 mg;观察组患者在对照组基础上增加纳布啡0.4 mg/kg。比较两组患者术后镇痛情况[疼痛视觉模拟评分(VAS)、镇痛泵有效按压次数、舒芬太尼用量、补救镇痛率]、术后恢复情况(首次下床活动、肛门排气时间、住院时间)、不良反应发生情况及术前、术后24、72 h外周静脉血T淋巴细胞亚群水平。结果:术后6、12、24、48 h,观察组患者VAS评分低于对照组(P<0.05)。术后48 h,观察组患者镇痛泵有效按压次数、舒芬太尼用量均少于对照组(P<0.05);补救镇痛率低于对照组(P<0.05)。术后,观察组患者首次下床活动时间及肛门排气时间较对照组缩短(P<0.05);住院时间较对照组缩短(P<0.05)。术后24 h,两组患者CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)均降低(P<0.05),但观察组高于对照组(P<0.05)。术后48 h内,观察组患者恶心呕吐发生率低于对照组(P<0.05);两组患者其他不良反应发生率比较,差异无统计学意义(P>0.05)。结论:腹腔镜直肠癌根治术后采用纳布啡联合舒芬太尼PCIA,能提升术后镇痛效果,有助于患者免疫功能的恢复。

Objective:To investigate the effect of nalbuphine combined with sufentanil patient-controlled intravenous analgesia(PCIA)on analgesic effect and immune function in patients undergoing laparoscopic radical resection of rectal cancer.Methods:102 patients undergoing laparoscopic radical resection of rectal cancer were selected and divided into control group and observation group according to different postoperative analgesia methods,51 cases in each group.Both groups were given the same anesthesia induction and maintenance,and PCIA pump was connected after operation.Patients in the control group were treated with sufentanil 2.0μg/kg+azastron 10 mg,and patients in the observation group received 0.4 mg/kg of nabuprofen on the basis of the control group.The postoperative analgesia[Visual analogue scale(VAS)scores,effective pressing times of analgesic pump,the dosage of sufentanil,and remedial analgesia rate],postoperative recovery(first ambulation time,anal exhaust time and hospitalization time),adverse reactions were recorded,and the levels of T lymphocyte subsets in peripheral venous blood were compared between the two groups before operation,24 and 72 h after operation.Results:The Visual analogue scale(VAS)scores of the observation group was lower than that of the control group at 6,12,24 and 48 h after operation(P<0.05).The effective pressing times of analgesic pump and the dosage of sufentanil in the observation group were less than those in the control group 48 h after operation(P<0.05),and the remedial analgesia rate was lower than that in the control group(P<0.05).After surgery,the first ambulation time,anal exhaust time and hospitalization time in the observation group were shortened than those in the control group(P<0.05).At 24 h after operation,the CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)ratios in the two groups were lower than those before operation(P<0.05),but the observation group was higher than the control group(P<0.05).The incidence of nausea and vomiting within 48 h after operation in the observation group was lower than that in the control group(P<0.05).There was no significant difference in other adverse reactions between the two groups(P>0.05).Conclusion:Nebuphine combined with sufentanil PCIA can improve the analgesic effect after laparoscopic radical resection of rectal cancer,improve the postoperative immune function.