羟考酮自控静脉镇痛对肺癌术后患者免疫功能及镇痛效果的影响

Effect of Oxycodone Patient-Controlled Intravenous Analgesia on Immune Function and Analgesic Efficacy in Postoperative Lung Cancer Patients

目的研究羟考酮用于患者自控静脉镇痛(PCIA)对肺癌术后患者免疫功能的影响。方法本研究为单中心、前瞻性、随机、对照、双盲试验。选择行胸腔镜下肺叶切除术患者120例,随机分配至羟考酮组(OC组)和舒芬太尼组(SF组)。2组患者采用相同的麻醉方法,术后采用无背景剂量PCIA:OC组为盐酸羟考酮100 mg^(+)多拉司琼25 mg;SF组为舒芬太尼100μg^(+)多拉司琼25 mg。使用生理盐水分别将2组药物稀释至100 mL。镇痛泵剂量设置为:首次剂量为10 mL,Bolus为4 mL,锁时5 min,背景剂量为0。主要观察指标:术前24 h(T_(0))和术后6 h(T_(1))、12 h(T_(2))、24 h(T_(3))、48 h(T_(4)),2组患者全血CD4^(+)、CD8^(+)T淋巴细胞和NK细胞的百分比。次要观察指标:T_(1)~T_(4)各时间点的镇静评分(Ramsay评分量表)、静态和动态视觉模拟评分(VAS)、T_(4)时镇痛泵按压次数、镇痛补救药物使用次数和不良反应、术后胸腔引流管留置时间及住院时间等。结果T_(1)、T_(2)和T_(3)时,OC组的CD4^(+)和CD8^(+)T细胞的百分比明显高于SF组;T_(4)时,OC组的CD4^(+)T细胞百分比仍明显高于SF组(P<0.05);T_(1)、T_(2)和T_(3)时,OC组NK细胞的百分比均明显高于SF组(P<0.05)。T_(4)时,SF组镇痛泵按压次数明显多于OC组(P<0.05)。2组患者不同时间点Ramsay评分、静态和动态VAS、并发症的差别均无统计学意义(P>0.05)。结论羟考酮和舒芬太尼用于肺癌术后PCIA均会对免疫功能产生抑制作用,但羟考酮的抑制作用较轻微、镇痛效果较好,更适宜肺癌患者术后PCIA。

Objective It is to study the effects of oxycodone used for patient-controlled intravenous analgesia(PCIA)on the immune function in postoperative lung cancer patients.Methods This study was a single-center,prospective,randomized,controlled,double-blind trial.A total of 120 patients undergoing thoracoscopic lobectomy were randomly assigned to the oxycodone group(OC group)or the sufentanil group(SF group).Both groups used the same anesthesia technique and postoperative PCIA without a background dose:OC group received 100 mg oxycodone hydrochloride and 25 mg ondansetron;SF group received 100μg sufentanil and 25 mg ondansetron.Both drugs were diluted to 100 mL in saline in the 2 groups,respectively.The analgesic pump dose was set as follows:The initial dose was 10 mL,Bolus dose was 4 mL,with a lockout interval of 5 min and no background infusion.Primary outcome measures included the percentages of whole blood CD4^(+)and CD8^(+)T lymphocytes and NK cells in patients at 24 hours preoperatively(T_(0))and at 6 hours(T_(1)),12 hours(T_(2)),24 hours(T_(3)),and 48 hours(T_(4))postoperatively.Secondary outcome measures included Ramsay sedation scores,static and dynamic visual analog scores(VAS)pain scores at each time point from T_(1)to T_(4),number of analgesic pump presses at T_(4),number of analgesic remedial drug use,adverse reactions,postoperative chest drainage retention time,and hospitalization stay.Results At T_(1),T_(2),and T_(3),the percentages of CD4^(+)and CD8^(+)T cells were significantly higher in the OC group than those in the SF group.At T_(4),the percentage of CD4^(+)T cells was significantly higher that in the OC group(P<0.05).At T_(1),T_(2),and T_(3),the percentages of NK cells were significantly higher in the OC group than those in the SF group(P<0.05).The SF group had significantly more analgesic pump presses than the OC group at T4(P<0.05).There were no significant differences in Ramsay scores,static and dynamic VAS scores,or complications at various time points between the two groups(P>0.05).Conclusion Both oxycodone and sufentanil used for postoperative PCIA in lung cancer patients suppress immune function;however,oxycodone has a milder suppressive effect and provides better analgesia,making it more suitable for PCIA after lung cancer surgery.