布托啡诺超前镇痛联合右美托咪定与舒芬太尼PCIA对妇科腹腔镜手术患者机体免疫功能及炎症反应的影响

Effect of butofinol advanced analgesia combined with dexmedetomidine and sufentanil PCIA on the immune function and inflammatory response in patients undergoing gynecological laparoscopic surgery

目的比较布托啡诺超前镇痛联合右美托咪定与舒芬太尼经患者自控静脉镇痛(PCIA)、布托啡诺超前镇痛PCIA对妇科腹腔镜手术患者机体免疫功能及炎症反应的影响。方法前瞻性选取2019年1月至2022年4月滁州市第一人民医院收治的80例行妇科腹腔镜手术患者,根据信封法将患者分为观察组(n=42)和对照组(n=38)。对照组术前采用布托啡诺超前镇痛PCIA,观察组术前采用布托啡诺超前镇痛联合右美托咪定与舒芬太尼PCIA。比较两组患者镇痛效果[视觉模拟评分法(VAS)评分]、术后苏醒时间、拔管时间、自主呼吸恢复时间、免疫功能(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、血清炎症因子[肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、白细胞介素6(IL-6)]及术后不良反应。结果术后6、12、24 h,观察组患者VAS评分分别为(2.98±0.92)、(2.04±0.47)、(1.36±0.43)分,均低于对照组[(3.47±0.89)、(2.84±0.53)、(1.59±0.50)分],差异均有统计学意义(P<0.05)。观察组患者自主呼吸恢复时间、拔管时间以及苏醒时间分别为(43.78±5.40)、(120.89±10.14)、(3.01±0.64)min均短于对照组[(60.32±6.77)、(162.48±9.42)、(4.04±0.72)min],差异均有统计学意义(P<0.05)。术后24 h,两组患者的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)较术前均降低,但观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)分别为(53.88±1.87)%、(25.48±1.58)%、0.96±0.10,均高于对照组[(48.36±1.74)%、(20.82±1.33)%、0.72±0.06],差异均有统计学意义(P<0.05)。术后24 h,两组患者的TNF-α、CRP、IL-6水平较术前均降低,且观察组TNF-α、CRP、IL-6水平分别为(2.94±0.37)pg/mL、(10.54±1.66)mg/L、(1.88±0.29)pg/mL,均低于对照组[(4.03±0.47)pg/mL、(14.99±2.17)mg/L、(2.47±0.32)pg/mL],差异均有统计学意义(P<0.05)。两组患者术后总不良反应率比较,差异无统计学意义(P>0.05)。结论布托啡诺超前镇痛联合右美托咪定与舒芬太尼PCIA术后镇痛效果更好,免疫功能更高,炎症反应更小,值得在临床推广使用。

Objective To compare the effects of butofinol advanced analgesia combined with dexmedetomidine and sufentanil patient-controlled intravenous analgesia(PCIA)on immune function and inflammatory response in patients undergoing gynecological laparoscopic surgery.Methods A prospective selection of 80 gynecological laparoscopic surgery patients admitted to Chuzhou First People's Hospital from January 2019 to April 2022 was conducted.According to the envelope method,the patients were divided into the observation group(n=42)and the control group(n=38).The control group used preoperative butolinol advanced analgesia PCIA,the observation group used preoperative advanced analgesia combined with dexmedetomidine and sufentanil PCIA.The analgesic effect[visual analogue scale(VAS)],postoperative awakening time,extubation time,recovery time of spontaneous respiration,immune function(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),serum inflammatory factors[tumor necrosis factor alpha(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6)],and postoperative adverse effects were compared between the two groups.Results At 6,12,and 24 hours after surgery,the VAS scores of the observation group patients were(2.98±0.92),(2.04±0.47),(1.36±0.43)points,respectively,which were lower than those of the control group[(3.47±0.89),(2.84±0.53),(1.59±0.50)points],and the differences were statistically significant(P<0.05).The recovery time of spontaneous breathing,extubation time,and awakening time of the observation group patients were(43.78±5.40),(120.89±10.14),(3.01±0.64)minutes,respectively,which were shorter than those of the control group[(60.32±6.77),(162.48±9.42),(4.04±0.72)minutes],and the differences were statistically significant(P<0.05).At 24 hours after surgery,the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in two groups were lower than those before surgery,but the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in the observation group were(53.88±1.87)%,(25.48±1.58)%,0.96±0.10,respectively,which were higher than those in the control group[(48.36±1.74)%,(20.82±1.33)%,0.72±0.06],and the differences were statistically significant(P<0.05).At 24 hours after surgery,the levels of TNF-α,CRP,and IL-6 in two groups were lower than those before surgery,and the levels of TNF-α,CRP,and IL-6 in the observation group were(2.94±0.37)pg/mL,(10.54±1.66)mg/L,(1.88±0.29)pg/mL,which were lower than those in the control group[(4.03±0.47)pg/mL,(14.99±2.17)mg/L,(2.47±0.32)pg/mL],and the differences were statistically significant(P<0.05).There was no statistically significant difference in the total postoperative adverse reaction rate between the two groups of patients(P>0.05).Conclusion Butorphinol advanced analgesia combined with dexmedetomidine and sufentanil PCIA has better analgesic effect,higher immune function and less inflammatory response,which should be used in clinical practice.