摘要
目的探讨右美托咪定对肺癌根治术后使用镇痛药吗啡及免疫功能的影响。方法选取2013年8月~2015年8月在医院择期行肺癌根治术患者84例作为研究对象,ASAⅠ~Ⅱ级,采用随机数表分为右美托咪定组和对照组各42例,右美托咪定组麻醉诱导时泵注右美托咪定0.05μg/kg·min-1,10min后以0.4μg/kg·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。观察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12h、13~24h吗啡用量及术后48h有效自控镇痛(PCA)次数;术后4h、12h、24h、48h发放视觉模拟评分(VAS)评估患者疼痛程度,麻醉诱导前(T0)、拔除气管即刻(T_1)、术后24h(T_2)、术后48h(T_3)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、拔管时间短于对照组(P<0.05);右美托咪定组术后12h、术后13~24h及48h有效PCA次数均少于对照组(P<0.05);与术后4h比较,两组术后12h、24h、48hVAS评分均明显下降(P<0.05),观察组术后4h、12h、24h、48hVAS评分低于对照组(P<0.05);与T0时比较,T_1、T_2、T_3时CD4^+、CD4^+/CD8^+均有所下降(P<0.05),CD8^+无明显变化(P>0.05),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%明显低于对照组中的38.10%(P<0.05)。结论围术期右美托咪定可减轻肺癌根治术患者围手术免疫抑制,减少术后吗啡用药剂量和使用PCA的次数。
Objective To investigate the effect of dexmedetomidine on analgesic morphine and immune function in patients after radical resection of lung cancer. Methods Eightyfour patients underwent elective radical resection of lung cancer （grade ASA I ~ II） in August 2013August 2015 were selected as study subjects. According to the random number table, they were divided into dexmedetomidine group and control group, 42 cases in each. Dexmedetomidine group was infused with dexmedetomidine at 0.05μg/kg·min^-1 when anesthesia induction, 10 min later. The dose was maintained at 04μg/kg·h^-1 till 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 postoperative 12h and 13 ~ 24h, the doses of morphine and the times of effective PCA at postoperative 48h were recorded. At postoperative 4h, 12h, 24h and 48 h, visual analogue scale （VAS） was issued to evaluate the pain degree in patients. Before anesthesia induction （T0）, on extubation （T1）, at postoperative 24h （T2） and 48h （T3）, T cells in peripheral blood were detected. Results The postoperative spontaneous breathing recovery time and extubation time of dexmedetomidine group were shorter than those of the control group （P 〈 0.05）. At postoperative 12h, 13 ~ 24h and 48h, the times of effective PCA in dexmedetomidine group was less than that in the control group （P 〈 0.05）; Compared with that at postoperative 4h, the VAS scores of the two groups at postoperative 12h, 24h and 48h were significantly lower （P 〈 0.05）. The VAS scores of the observation group at postoperative 12h, 24h and 48h were lower than those of the control group （P 〈 0.05）. Compared with those at T0, CD4＋ and CD4＋/CD8＋ at T1, T2 and T3 were lower （P 〈 0.05）, while there was no
出处
《西部医学》
2018年第1期64-67,71,共5页
Medical Journal of West China
基金
四川省科技厅科技支撑计划项目(2013SZ15340)
关键词
肺癌
根治术
右美托咪定
自控镇痛
吗啡
免疫功能
Lung cancer
Radical resection
Dexmedetomidine
Morphine
Immune function
