摘要
目的探讨舒芬太尼静脉自控镇痛对腹腔镜肾癌根治术患者镇痛效果、免疫功能和应激反应的影响。方法将2018年2月至2019年6月于邯郸市中心医院收治的行腹腔镜肾癌根治手术治疗的晚期肾癌术后患者64例,随机分为对照组和研究组,每组32例。2组患者于术后立即分别给与芬太尼(对照组)和舒芬太尼(研究组)静脉自控镇痛。比较2组麻醉诱导前、拔管前10 min、拔管时、拔管后10 min的生命体征[心率(HR)、指脉氧饱和度(SpO_(2))、平均动脉压(MAP)]。比较2组干预前及干预后12 h、24 h的视觉模拟(VAS)评分和疼痛分级法(NRS)评分;比较2组干预前及干预后12 h、24 h患者免疫功能相关指标(CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+)、IgG、IgM、IgA)以及应激指标[去甲肾上腺素(NE)、皮质醇(Cor)、C-反应蛋白(CRP)]改善情况。结果2组麻醉诱导前、拔管前10 min、拔管时、拔管后10 min的HR、SpO_(2)及MAP比较,差异无统计学意义(P>0.05)。与干预前比较,干预后2组12 h、24 h的VAS、NRS评分均显著降低,差异均有统计学意义(P<0.05)。与干预前比较,干预后2组患者血清中CD_(8)^(+)、NE、Cor、CRP含量均显著增高,CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)、IgG、IgM、IgA含量均显著降低,差异均有统计学意义(P<0.05)。与对照组比较,研究组患者12 h、24 h的VAS、NRS评分均显著降低,血清中CD_(8)^(+)、NE、Cor、CRP含量显著降低,CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)、IgG、IgM、IgA含量则显著增高,差异均有统计学意义(P<0.05)。结论晚期肾癌腹腔镜根治术后使用舒芬太尼自控镇痛较芬太尼具有更好的镇痛作用,并且能够有效缓解肾癌手术患者的应激反应,改善患者术后的免疫功能。
Objective To investigate the effects of sufentanil intravenous patient-controlled analgesia on the analgesic effects,immune function and stress response of patients undergoing laparoscopic radical nephrectomy.Methods A total of 64 patients with advanced renal cancer who were treated by laparoscopic radical nephrectomy in our hospital from February 2018 to June 2019 were enrolled in the study,who were randomly divided into control group and research group,with 32 cases in each group.The patients in control groups were treated by fentanyl analgesia,however,those in research group were treated by sufentanil intravenous patient-controlled analgesia after surgery.The vital signs[heart rate(HR),finger pulse oxygen saturation(SpO_(2)),mean arterial pressure(MAP)]before induction of anesthesia,10 minutes before extubation,during extubation,and 10 minutes after extubation,and the visual analogue(VAS)scores and pain grading method(NRS)scores before intervention and at 12h and 24h after intervention,and the immune function-related indexes(CD_(3)^(+),CD_(4)^(+),CD_(8)^(+),CD_(4)^(+)/CD_(8)^(+),IgG,IgM,IgA)as well as stress indexes[norepinephrine(NE),cortisol(Cor),C-reactive protein(CRP)]were observed and compared between the two groups.Results There were no significant differences in the levels of HR,SpO_(2) and MAP before induction of anesthesia,10 min before extubation,during extubation,and at 10 min after extubation between the two groups(P>0.05).Compared with those before the intervention,the VAS scores and NRS scores at 12h and 24h after intervention in both groups were significantly decreased(P<0.05),however,the serum levels of CD_(8)^(+),NE,Cor,and CRP were significantly increased,and the levels of CD_(3)^(+),CD_(4)^(+),CD_(4)^(+)/CD_(8)^(+),IgG,IgM,and IgA levels were significantly decreased(P<0.05).Compared with those in control group,the VAS scores and NRS scores at 12h and 24h after intervention,and the serum levels of CD_(8)^(+),NE,Cor,and CRP in research group were significantly decreased,however,the levels of C
作者
徐辉
尤校雷
谷峪
李明谦
刘炜
XU Hui;YOU Xiaolei;GU Yu(Hanxing Workers General Hospital of Wukuang Company,Hebei,Handan 056001,China;不详)
出处
《河北医药》
CAS
2022年第14期2133-2137,共5页
Hebei Medical Journal
基金
河北省医学科学研究重点课题计划(编号:20210072)。
关键词
舒芬太尼
晚期肾癌
腹腔镜手术
自控镇痛
应激反应
免疫功能
sufentanyl
advanced renal cancer
laparoscopic surgery
patient controlled analgesia
stress response
immune function
