摘要
目的观察腹腔镜子宫切除患者静脉靶向控制输注(TCI)舒芬太尼后T淋巴细胞亚群、血清血栓素A2(TXA2)及前列环素(PGI2)水平变化情况,以指导该类手术麻醉性镇痛方式的选择。方法回顾性分析2018年5月-2019年12月在该院接受腹腔镜子宫切除术治疗且术中采取间断推注舒芬太尼的40例患者的临床资料,将其纳入对照组;收集其他符合条件的经舒芬太尼TCI模式给药的41例患者的临床资料,将其纳入研究组。比较两组患者入室时、术后2 h、术后24 h、术后48 h时的T淋巴细胞亚群(CD4+、CD8+、CD4+/CD8+);比较两组患者入室时、气腹后15 min、解除气腹15 min时的6-酮—前列腺素F1α(6-Ke-to-PGF1α)、血栓素B2(TXB2)、TXB2/6-Ke-to-PGF1α水平;比较两组患者围术期不良反应发生率。结果术后2 h、24 h、48 h时,两组患者CD4+、CD4+/CD8+水平较入室时均降低,CD8+水平较入室时升高,且研究组患者的CD4+、CD4+/CD8+水平高于对照组,CD8+水平低于对照组,差异均有统计学意义(均P<0.05)。气腹后15 min、解除气腹15 min时,两组患者TXB2、6-Ke-to-PGF1α水平均高于入室时,且对照组TXB2/6-Ke-to-PGF1α水平高于入室时,研究组患者TXB2/6-Ke-toPGF1α水平低于入室时,差异均有统计学意义(均P<0.05);气腹后15 min、解除气腹15 min时,研究组患者的TXB2、TXB2/6-Ke-to-PGF1α水平低于对照组,6-Ke-to-PGF1α水平高于对照组,差异均有统计学意义(均P<0.05)。研究组患者的不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论腹腔镜子宫切除患者采取舒芬太尼TCI可有效提高免疫功能,可较好地维持TXA2/PGI2平衡,降低不良反应发生率,安全性较高,值得推广。
Objective To observe the changes of T lymphocyte subgroups and serum thromboxane A2 (TXA2) and prostacyclin (PGI2) levels after target-controlled infusion of sufentanil in patients undergoing laparoscopic hysterectomy,direct the selection of anesthesia and analgesia methods in laparoscopic hysterectomy. Methods From May 2018 to December 2019,40 patients undergoing laparoscopic hysterectomy and discontinuous intravenous infusion of sufentanil were selected as control group,41 patients undergoing laparoscopic hysterectomy and target-controlled infusion of sufentanil were selected as study group. T lymphocyte subgroups (CD4+,CD8+,CD4+/CD8+) at the time of entering operation room,at 2,24,and 48 hours after operation in the two groups were compared. The levels of 6-Ke-to-PGF1α,thromboxane B2 (TXB2),TXB2/6-Ke-to-PGF1α at the time of entering operation room,at 15 minutes after establishment of pneumoperitoneum,at 15 minutes after disappearance of pneumoperitoneum in the two groups were compared. The incidence rates of adverse reactions during perioperative period in the two groups were compared. Results At 2,24,and 48 hours after operation,the levels of CD4+T lymphocyte subgroup,CD4+/CD8+T lymphocyte subgroup ratio in the two groups were lower than those at the time of entering operation room,while CD8+lymphocyte subgroup ratio were higher than that at the time of entering operation room,the levels of CD4+T lymphocyte subgroup,CD4+/CD8+T lymphocyte subgroup ratio in study group were higher than those in control group,while CD8+lymphocyte subgroup ratio were lower than that in control group,there were statistically significant differences (P<0. 05). At 15 minutes after establishment of pneumoperitoneum and 15 minutes after disappearance of pneumoperitoneum,the levels of TXB2 and 6-Ke-to-PGF1α in the two groups were higher than those at the time of entering operation room,TXB2/6-Ke-to-PGF1α level in control group was higher than that at the time of entering operation room,TXB2/6-Ke-to-PGF1α level in study group was l
作者
程晨
CHENG Chen(Jinhua People's Hospital,Jinhua,Zhejiang 321000,China)
出处
《中国妇幼保健》
CAS
2020年第20期3888-3891,共4页
Maternal and Child Health Care of China
