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[摘要]
目的 比较地佐辛与舒芬太尼经静脉患者自控镇痛(PCIA)给药对食管癌患者术后的镇痛效果。方法 116例择期行食管癌根治术的患者随机分为地佐辛组(n=58)和舒芬太尼组(n=58),两组患者麻醉方法及麻醉药物使用均相同,术毕给予PCIA,地佐辛组药物为0.8 mg/kg地佐辛和6 mg托烷司琼用生理盐水配制成100 mL,舒芬太尼组药物为舒芬太尼2.5 μg/kg和托烷司琼6 mg用生理盐水配制成100 mL。记录两组患者术后48 h内PCIA按压次数和镇痛药物累积消耗量,计算有效按压率;分别于术后6h (T2)、12 h (T3)、24 h (T4)和48 h (T5)评估疼痛视觉模拟量表(VAS)评分,分别于术前(T0)、T1、T3、T4和T5时检测T细胞亚群CD3+、CD4+、CD8+和NK细胞,记录两组患者术后不良反应发生情况。结果 地佐辛组患者术后48 h内按压次数和镇痛药物累积消耗量分别为(5.1±2.2)次和(60.6±11.2) mL,低于舒芬太尼组(7.2±2.6)次和(88.8±9.1) mL (P<0.05);地佐辛组患者T2~5时安静时VAS评分[(2.1±0.9)、(1.9±0.6)、(2.0±0.5)、(1.7±0.4)分]和活动时VAS评分[(2.6±1.1)、(2.2±0.8)、(2.3±0.7)、(1.9±0.8)分]均低于舒芬太尼组(P<0.05);与舒芬太尼组相比,地佐辛组患者T3~5时CD3+细胞[(57.8±9.2)%、(62.3±7.8)%、(66.3±9.5)%]均升高,T3时CD4+[(27.8 ±6.8)%]升高,T3~4时CD4+/CD8+比值[(1.15±0.62)、(1.24±0.52)]和NK细胞[(20.2±6.9)%、(21.3±4.9)%]升高,差异均有统计学意义(P<0.05);地佐辛组患者术后总不良反应发生率22.4%,显著低于舒芬太尼组的39.7%(P<0.05)。结论 与舒芬太尼相比,地佐辛应用于食管癌患者术后镇痛,可提高镇痛效果、改善患者机体细胞免疫功能、减少术后不良反应的发生。
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[Abstract]
Objective To investigate the differences of dezocine on postoperative analgesia and cellular immune function in patients with esophageal cancer.Methods A total of 116 cases of patients undergoing elective esophageal cancer surgery were randomly divided into dezocine group (n=58) and sufentanil group (n=58).Patients in the two groups were taken the same anesthesia method and anesthesia drugs.After surgery,the patients in the two groups were connected PCIA.The formula in the dezocine group:dezocine 0.8 mg/kg and sufentanil tropisetron 6 mg were formulated with saline for 100 mL,and in the sufentanil group:sufentanil 2.5 μg/kg and 6 mg tropane were formulated with saline for 100 mL.The number of PCIA compressions and the cumulative consumption of analgesic drugs within 48 h after surgery were recorded,and the effective compression rate was calculated.After surgery 6 h (T2),12 h (T3),24 h (T4) and 48 h (T5),respectively.The VAS scores in different points were assessed by using pain visual analog scale (VAS).Respectively,before surgery (T0),T1,T3,T4 and T5,the T cell subsets of CD3+,CD4+,CD8+ and NK cells were detected.The adverse reactions after surgery in the two groups were recorded.Results The number of PCIA compressions and the cumulative consumption of analgesic drugs within 48 h after surgery were (5.1±2.2) times and (60.6±11.2) mL,respectively,which were less than the sufentanil group,which were (7.2±2.6) times and (88.8±9.1) mL,respectively,the differences were statistically significant (P<0.05).The VAS scores in the dezocine group at T2~5[(2.1±0.9),(1.9±0.6),(2.0±0.5),(1.7±0.4)]and[(2.6±1.1),(2.2±0.8),(2.3±0.7),(1.9±0.8)]were lower than the sufentanil group,the differences were statistically significant (P<0.05).Compared with the sufentanil group,the CD3+ cells in the dezocine group at T3-5[(57.8±9.2)%,(62.3±7.8)%,(66.3±9.5)%]were increased,CD4+cells at T3[(27.8±6.8)%]was increased,the proportions of CD4+/CD8+[(1.15±0.62),(1.24±0.52)]and NK cells[(20.2±6.9)%,(21.3±4.9)%]at T3-4 were increased,the differences were statistically significant (P<0.05).The total incidence of adverse reactions in the dezocine group was 22.4%,which was significantly lower than the sufentanil group,which was 39.7%,the difference was statistically significant (P<0.05).Conclusion Compared with sufentanil,dezocine applied in postoperative analgesia of patients with esophageal cancer could improve the analgesic effect,improve the patients'immune function,and reduce the incidence of postoperative adverse reactions.
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[基金项目]
河南省2015年科技发展计划项目(152300410164)