右美托咪定复合舒芬太尼病人自控静脉镇痛对胸腔镜下肺癌根治术病人术后免疫功能及呼吸功能恢复的影响被引量：1

Effects of patient-controlled analgesia with dexmedetomidine combined with sufentanil on postoperative immune function and recovery of respiratory function in patients undergoing thoracoscopic radical resection of lung cancer

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摘要目的探讨右美托咪定(dexmedetomidine,Dex)复合舒芬太尼静脉病人自控静脉镇痛(PCIA)对胸腔镜下肺癌根治术病人术后免疫功能和呼吸功能恢复的影响。方法2020年10月~2022年6月在我院选择ASAⅠ或Ⅱ级择期行胸腔镜下肺癌根治术病人92例,按随机数字表分为舒芬太尼PCIA组(S组)和Dex复合舒芬太尼PCIA组(D组),每组46例,S组有1例术后出血,退出实验,D组有1例术中大出血,退出实验。S组术后PCIA采用舒芬太尼注射液每天1.0μg/kg+盐酸托烷司琼20 mg/150 ml,D组采用Dex每天1.0μg/kg+舒芬太尼注射液每天1.0μg/kg+盐酸托烷司琼20 mg/150ml。记录病人术前1天(T_(0)),术后24小时(T_(1))、48小时(T_(2))、72小时(T_(3))四个时间点的静息、咳嗽疼痛数字评分量表(NRS)评分,SAS评分,抽取静脉血检测CD3^(+)、CD4^(+)、CD8^(+)、CRP、PCT,动脉血行血气分析,计算氧合指数(OI);在T_(2)进行临床肺部感染评分(CPIS)、记录低氧血症、肺水肿、不良反应恶心呕吐、嗜睡、心动过缓、呼吸抑制及寒战的发生情况。结果与S组比较,D组在T_(1)、T_(2)、T_(3)三个时间点,静息、咳嗽NRS评分,SAS评分、CRP、PCT均明显降低,差异有统计学意义(P<0.05),CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、OI值升高,CD8^(+)仅在T_(1)较低(P<0.05);T_(0)时两组静息、咳嗽NRS评分,SAS评分,CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),CRP,PCT,OI比较,差异无统计学意义(P>0.05),与T_(0)时比较,两组病人在T_(1)、T_(2)、T_(3)三个时间点静息、咳嗽NRS评分、CRP、PCT明显升高,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、OI、SAS评分降低,CD8^(+)仅在T_(1)、T_(2)升高(P<0.05)。与S组比较,D组恶心呕吐比例和CPIS评分降低[8(17.8%)例、(3.5±1.3)分vs.1(2.2)例、(1.2±1.1)分],低氧血症和肺水肿发生率、嗜睡、心动过缓、呼吸抑制、寒战比例比较,差异无统计学意义(P>0.05)。结论Dex复合舒芬太尼PCIA具有较好的镇痛、镇静效果,即减轻了手术创伤造成的免疫功能抑制程度,又减少阿片类药物的不良反应,还有利于病人术后呼吸功能的恢复,是胸腔镜下肺癌根治术后较安全的PCIA方式。 Objective To investigate the effects of dexmedetomidine(DEX)combined with sufentanil for patient-controlled intravenous analgesia(PCIA)on postoperative immune function and respiratory function recovery in patients undergoing thoracoscopic radical resection of lung cancer.Method From October 2020 to June 2022,92 ASAⅠorⅡpatients scheduled for thoracoscopic radical resection of lung cancer were selected in our hospital,and they were randomly divided into sufentanil group(Group S)and DEX group(Group D)with 46 cases in each group.There was one case of postoperative bleeding in group S and one case of intraoperative bleeding in group D withdrew from the experiment.the group S postoperative PCIA with sufentanil injection 1.0μg/kg pre day and tropisetron hydrochloride 20 mg/150 ml,Group D was treated with dexmedetomidine 1.0μg/kg pre day and sufentanil injection 1.0μg/kg pre day and tropisetron hydrochloride 20 mg/150 ml.At the four time points in preoperative day(T_(0)),24 h(T_(1)),48h(T_(2))and 72 h(T_(3))after operation.Rest and cough NRS scores and SAS scores were recorded and venous blood samples were taken to detected CD3^(+),CD4^(+),CD8^(+),CRP and PCT,Arterial blood gas analysis was detected to calculate OI;clinical pulmonary infection score(CPIS),the incidence of hypoxemia and pulmonary edema and adverse reactions including nausea and vomiting,drowsiness,bradycardia,respiratory depression and shivers were recorded at T_(2).Results Compared with S group,NRS score of resting or cough,SAS score,CRP and PCT of group D were significantly decreased at T_(1) to T_(3)(P<0.05),while CD3^(+),CD4^(+),CD4^(+)/CD8^(+)and OI value was increased,CD8^(+)was only lower in T_(1)(P<0.05).There were no significant differences in rest and cough NRS scores、SAS scores、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、CRP,PCT and OI between the two groups at T_(0)(P>0.05).Compared with T_(0),Rest and cough NRS scores、CRP and PCT were significantly increased,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、OI and SAS scores were decreased in the two groups at T_(1)-T_(3),CD8^(+)increased only at T_(1) and T_(2)(P<0.05).Compared with group S[8(17.8%),(3.5±1.3)],the proportion of nausea and vomiting and CPIS score in group D[1(2.2%),(1.2±1.1)]was decreased(P<0.05).There was no significant difference in the proportion of hypoxemia,pulmonary edema,drowsiness,bradycardia,respiratory depression and shivers(P>0.05).Conclusion Dexmedetomidine combined with sufentanil patient-controlled analgesia has better analgesic and sedative effects,which can not only reduce the degree of immunosuppression caused by surgical trauma,but also reduce the adverse reactions of opioids,and is conducive to the recovery of postoperative respiratory function.It is a safer PCIA method after thoracoscopic radical resection of lung cancer.

作者刘玉婷文进秋侯彦深郭明珊艾孜买提·艾尼瓦尔热孜亚·艾尔肯张冰 LIU Yuting;WEN Jinqiu;HOU Yanshen;GUO MingShan;Aizimaiti·Aniwaer;Reziya·Aierken;ZHANG Bing(Department of Anesthesiology,Cancer Hospital Affiliated to Xinjiang Medical University,Urumqi,Xinjiang 830000,China)

机构地区新疆医科大学附属肿瘤医院麻醉科

出处《临床外科杂志》 2024年第7期767-771,共5页 Journal of Clinical Surgery

基金新疆维吾尔自治区自然科学基金(2020D01C209)。

关键词右美托咪定肺癌根治术自控镇痛免疫功能呼吸功能 Dexmedetomidine radical resection of lung cancer patient controlled analgesia immune function respiratory function

分类号 R614 [医药卫生—麻醉学]