舒芬太尼联合艾司氯胺酮自控镇痛对肠道肿瘤根治术后患者免疫调节细胞及炎症因子的影响

Effect of Patient-controlled Analgesia with Sufentanil Combined with Esketamine on Immunomodulatory Cells and Inflammatory Factors in Patients after Radical Resection of Intestinal Tumors

目的:分析艾司氯胺酮联合舒芬太尼自控镇痛对肠道肿瘤根治术后患者免疫调节细胞及炎症因子的影响。方法:选取2023年1—9月广州医科大学附属清远医院胃肠外科收治的120例肠道肿瘤根治术患者,采用随机数字表法分为研究组(n=60)和对照组(n=60)。对照组术后自控镇痛药物为舒芬太尼,研究组为舒芬太尼联合艾司氯胺酮。比较两组免疫调节细胞、应激及炎症指标、血气指标、镇痛评分、心率、血压及不良反应。结果:用药后,两组正向免疫调节细胞均上升,且研究组均较对照组高,负向免疫调节细胞均下降,且研究组均较对照组低(P<0.05);用药后,两组应激及炎症指标均下降,且研究组均较对照组低(P<0.05);两组术后24、48 h血气指标均改善,且研究组术后48 h动脉血二氧化碳分压(PaCO_(2))低于对照组,术后24、48 h动脉血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))均高于对照组(P<0.05);研究组术后24 h运动数字分级评分法(NRS)评分低于对照组(P<0.05);研究组不良反应发生率低于对照组(5%vs 18%),差异有统计学意义(P<0.05)。结论:肠道肿瘤根治术后患者使用艾司氯胺酮联合舒芬太尼自控镇痛,更有利于恢复免疫调节细胞平衡,改善应激及炎症指标,且安全性高。

Objective:To analyze the effect of patient-controlled analgesia with Sufentanil combined with Esketamine on immunomodulatory cells and inflammatory factors in patients after radical resection of intestinal tumors.Method:A total of 120 patients with radical resection of intestinal tumors admitted to Department of Gastrointestinal Surgery,Qingyuan Hospital Affiliated to Guangzhou Medical University from January to September 2023 were selected and divided into study group(n=60)and control group(n=60)by random number table method.The postoperative patient-controlled analgesia drug was Sufentanil in the control group and Sufentanil combined with Esketamine in the study group.Immunomodulatory cells,stress and inflammation indexes,blood gas indexes,analgesia scores,heart rate,blood pressure and adverse reactions were compared between the two groups.Result:After medication,positive immunomodulatory cells of both groups were increased,and those in the study group were higher than those in the control group,and negative immunomodulatory cells of both groups were decreased,and those in the study group were lower than those in the control group(P<0.05).After medication,the stress and inflammation indexes of both groups were decreased,and those in the study group were lower than those in the control group(P<0.05).The blood gas indexes of both groups were improved 24 and 48 h after surgery,and the arterial partial pressure of carbon dioxide(PaCO_(2))48 h after surgery in the study group was lower than that in the control group,and the arterial oxygen saturation(SaO_(2))and arterial partial pressure of oxygen(PaO_(2))24,48 h after surgery were higher than those in the control group(P<0.05).The score of numerical rating scale(NRS)24 h after surgery in the study group was lower than that in the control group(P<0.05).The incidence of adverse reactions in the study group was lower than that in the control group(5%vs 18%),the difference was statistically significant(P<0.05).Conclusion:The use of patient-controlled analgesia with Sufentanil combined with Esketamine in patients with radical resection of intestinal tumors is more conducive to restoring the balance of immunomodulatory cells,improving stress and inflammation indexes,and has high safety.