羟考酮超前镇痛对VATS患者术后疼痛及免疫功能的影响

Effect of preemptive analgesia with oxycodone on postoperative pain and immune function in patients undergoing VATS

目的探讨羟考酮超前镇痛对电视辅助胸腔镜手术(video-assisted thoracic surgery,VATS)患者术后疼痛及免疫功能的影响。方法选取美国麻醉师协会分级Ⅰ~Ⅱ级拟在全身麻醉下接受VATS的患者80例,随机分为试验组和对照组,每组40例。试验组给予羟考酮0.1 mg/kg静脉注射,对照组给予生理盐水0.1 mg/kg静脉注射。比较2组疼痛视觉模拟评分(visual analogue score,VAS)、镇痛相关不良事件发生率,术后肺部炎症发生率,术后觉醒时间,住院时间血清CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)比值、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、C反应蛋白(C-reactive protein,CRP),c-Fos mRNA水平。结果随时间延长,2组内脏痛和切口痛VAS评分均呈逐渐升高趋势,试验组内脏痛和切口痛VAS评分小于对照组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。试验组术后恶心、醒时躁动、肺部炎症发生率小于对照组,差异有统计学意义(P<0.05)。2组CD4^(+)水平均呈逐渐降低趋势,试验组降低幅度小于对照组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组CD8^(+)水平变化不明显,试验组CD8^(+)水平低于对照组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组CD4^(+)/CD8^(+)比值均呈逐渐升高趋势,试验组CD4^(+)/CD8^(+)比值大于对照组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组TNF-α、CRP水平均呈逐渐升高趋势,试验组TNF-α、CRP水平低于对照组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。术后15~30 min,2组血清c-Fos mRNA水平显著高于术前,试验组血清c-Fos mRNA水平显著低于对照组,差异有统计学意义(P<0.05)。结论羟考酮超前镇痛方案可调节VATS患者术后疼痛应激反应蛋白水平,减少炎症反应,同时还可降低炎症反应造成患者术后免疫抑制的能力,有利于术后恢复。

Objective To explore the effect of preemptive analgesia with oxycodone on postoperative pain and immune function in patients undergoing video assisted thoracoscopic surgery(VATS).Methods A total of 80 patients classified by the American Association of Anesthesiologists as GradeⅠ-Ⅱwho planned to receive VATS under general anesthesia were selected,and randomly divided into the experimental group(n=40)and the control group(n=40).The experimental group received intravenous injection of 0.1 mg/kg oxycodone,while the control group received intravenous injection of 0.1 mg/kg physiological saline.The visual analog score(VAS)of pain,incidence of pain-related adverse events,incidence of postoperative pulmonary inflammation,postoperative awakening time,length of hospital stay,serum CD4^(+),CD8^(+),CD4^(+)/CD8^(+)ratios,and tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)and c-Fos mRNA levels were compared between two groups.Results With the prolongation of time,the VAS scores of visceral pain and incision pain in both groups showed a gradually increasing trend.The VAS scores of visceral pain and incision pain in the experimental group were lower than those in the control group,and there was a statistically significant difference in the interaction between groups,time points,and time points between groups(P<0.05).The incidence of postoperative nausea,restlessness during awakening,and pulmonary inflammation in the experimental group was lower than that in the control group,and the difference was statistically significant(P<0.05).The CD4^(+)in both groups showed a gradual decreasing trend,with the experimental group showing a smaller decrease compared to the control group;there was a statistically significant difference in the interaction between groups,time points,and time points between groups(P<0.05).The changes in CD8^(+)were not significant in the two groups,and the CD8^(+)in the experimental group was lower than that in the control group.There was a statistically significant difference in the interaction between groups,time points,and time points between groups(P<0.05).The CD4^(+)/CD8^(+)ratio in both groups showed a gradually increasing trend,and the CD4^(+)/CD8^(+)ratio in the experimental group was greater than that in the control group.There was a statistically significant difference in the interaction between groups,time points,and time points between groups(P<0.05).Both TNF-αand CRP levels showed a gradual upward trend in the two groups,and TNF-αand CRP levels were lower in the experimental group than in the control group;There was a statistically significant difference in the interaction between groups,time points,and time points between groups(P<0.05).At 15-30 min after surgery,the serum c-Fos mRNA levels in the two groups were significantly higher than those before surgery,while the serum c-Fos mRNA levels in the experimental group were significantly lower than those in the control group,with a statistically significant difference(P<0.05).Conclusion The regimen of preemptive analgesia with oxycodone can regulate the levels of pain stress response proteins after surgery in patients with VATS,reduce inflammatory reactions,and also reduce the ability of patients to undergo postoperative immune suppression caused by inflammatory reactions,which is beneficial for postoperative recovery.