摘要
目的探讨右美托咪定对肺癌根治术后吗啡镇痛用量及免疫功能的影响。方法选取择期行肺癌根治术患者84例作为研究对象,ASAⅠ~Ⅱ级,采用随机数字表法分为右美托咪定组和对照组,每组42例,右美托咪定组麻醉诱导时泵注右美托咪定0.05μg·kg^(-1)·min^(-1),10 min后以0.2~0.4μg·kg^(-1)·h^(-1)维持至术毕,对照组术中采用同样方法给予同等剂量的生理盐水。统计术后自主呼吸恢复时间、拔管时间、镇痛期间不良反应,记录术后0~12、>12~24 h吗啡用量及术后48 h有效自控静脉镇痛泵(PCIA)次数;术后4、12、24、48 h进行视觉模拟评分(VAS)评估患者疼痛程度,麻醉诱导前(T0)、拔除气管即刻(T1)、术后24 h(T2)、术后48 h(T3)检测外周血T淋巴细胞。结果右美托咪定组术后自主呼吸恢复时间、拔管时间与对照组比较差异无统计学意义(P>0.05);两组术后>12~24 h吗啡累计用量显著高于0~12 h,差异有统计学意义(P<0.05),且右美托咪定组术后0~12、>12~24 h吗啡累计用量及48 h有效PCIA次数均少于对照组(P<0.05);VAS组间比较、时间点比较、组间×时间点比较均差异有统计学意义(P<0.05),且右美托咪定组术后4、12、24、48 h VAS评分低于对照组(P<0.05);CD4^+、CD4+/CD8^+组间比较、时间点比较、组间×时间点比较均差异有统计学意义(P<0.05),而CD8+比较差异有统计学意义(P>0.05),且与对照组不同时间点比较,右美托咪定组T_1、T_2、T_3时CD4^+、CD4^+/CD8^+均高于对照组(P<0.05);右美托咪定组镇痛期间不良反应发生率为16.67%,明显低于对照组中38.10%(P<0.05)。结论右美托咪定可减轻肺癌根治术患者围手术期免疫抑制,减少术后吗啡用药剂量,且不会造成苏醒延迟。
Objective To investigate the effects of dexmedetomidine on dose of morphine and immune function in patients with lung cancer after radical resection.MethodsEighty four patients who underwent elective radical resection of lung cancer were selected as study subjects,grade ASAⅠtoⅡ.According to the random number table,they were assigned into dexmedetomidine group and control group,42cases in each.Dexmedetomidine group was infused with dexmedetomidine at0.05μg·kg-1·min-1when anesthesia induction,10min later,the dose was maintained at0.2to0.4μg·kg-1·h-1till the end of operation.The control group was infused with the same dose of normal saline during operation.The postoperative spontaneous breathing recovery time,extubation time and adverse reactions during analgesia were statistically analyzed.At postoperative0to12h and>12to24h,the doses of morphine and the times of effective patient controlled intravenous analgesia(PCIA)at postoperative48h were recorded;at postoperative4,12,24and48h,visual analogue scale(VAS)was issued to evaluate the pain degree in patients.Before anesthesia induction(T0),on extubation(T1),at postoperative24h(T2)and48h(T3),T cells in peripheral blood were detected.ResultsThere were no significant differences in postoperative spontaneous breathing recovery time and extubation time between dexmedetomidine group and the control group(P>005);the morphine cumulative dosage at postoperative>12h to24h was significantly higher than that of postoperative0h to12h between the two groups,the difference was statistically significant(P<0.05);and morphine cumulative dosages at postoperative012h,1324h and the times of effective PCIA in dexmedetomidine group were less than those in the control group(P<0.05);the VAS score between the two groups decreased with the extension of time(P<0.05),and the VAS scores of the dexmedetomidine group at postoperative12,24and48h were lower than those of the control group(P<0.05);the CD4+and CD4+/CD8+between the two groups decreased first and then increased(P<0.05),the lowest point was at T2(P<0.05),but the trend of CD8+was not significant(P>0.05);and CD4+and CD4+/CD8+in dexmedetomidine group at T1,T2and T3were higher than those in the control group at different time points(P<0.05);the incidence of adverse reactions in dexmedetomidine group during analgesia(16.67%)was significantly lower than that in the control group(38.10%)(P<0.05).ConclusionsThe application of dexmedetomidine in perioperative period can reduce perioperative immunosuppression and dose of morphine postoperatively used,without causing delayed recovery.
作者
陈杰华
马海燕
CHEN Jiehua;MA Haiyan(Department of Anesthesiology,Central Hospital of Huangshi City,Huangshi,Hubei 435000,China;Department of Anesthesiology,Maternal and Child Health Care Hospital of Huangshi City,Huangshi,Hubei 435000,China)
出处
《安徽医药》
CAS
2017年第12期2299-2303,共5页
Anhui Medical and Pharmaceutical Journal
关键词
肺癌
根治术
右美托咪定
吗啡
免疫功能
Lung cancer
Radical resection
Dexmedetomidine
Morphine
Immune function
