中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2019, Vol. 48 ›› Issue (9): 794-800.doi: 10.12007/j.issn.0258-4646.2019.09.007

• 论著 • 上一篇    下一篇

右美托咪定联合酮咯酸氨丁三醇对胸腔镜肺癌根治术术后患者疼痛及免疫功能的影响

王乐1, 闻庆平1, 苗壮1, 周发忱2, 姜菲菲1, 林云1   

  1. 1. 大连医科大学附属第一医院 麻醉科, 辽宁 大连 116011;
    2. 大连医科大学附属第一医院 胸外科, 辽宁 大连 116011
  • 收稿日期:2019-03-21 出版日期:2019-09-30 发布日期:2019-09-12
  • 通讯作者: 苗壮 E-mail:18098876195@163.com
  • 作者简介:王乐(1978-),女,主管护师,本科.
  • 基金资助:
    辽宁省自然科学基金(20180551083)

Effect of Dexmedetomidine Combination with Ketorolac on Postoperative Pain and Immune Function in Patients with Lung Cancer Undergoing Thoracoscopic Radical Resection

WANG Le1, WEN Qingping1, MIAO Zhuang1, ZHOU Fachen2, JIANG Feifei1, LIN Yun1   

  1. 1. Department of Anesthesiology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China;
    2. Department of Thoracic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
  • Received:2019-03-21 Online:2019-09-30 Published:2019-09-12

摘要: 目的 探讨右美托咪定(DEX)联合酮咯酸氨丁三醇对胸腔镜肺癌根治术术后患者的镇痛作用及其对免疫功能的影响。方法 选择择期行胸腔镜肺癌根治手术患者60例,ASAⅠ~Ⅱ级,年龄18~65岁,患者采用随机数表分为舒芬太尼联合酮咯酸氨丁三醇组(SK组)和DEX联合酮咯酸氨丁三醇组(DK组),每组30例。术后使用静脉自控镇痛(PCIA),SK组给予舒芬太尼(0.04μg·kg-1·h-1)、酮咯酸氨丁三醇(3 mg/kg);DK组给予DEX(0.1 μg·kg-1·h-1)、酮咯酸氨丁三醇(3 mg/kg)。镇痛时间48 h,负荷剂量2mL,背景输注速率2 mL/h,锁定时间20 min。记录2组麻醉诱导前(T0),PCIA后即刻(T1)、4 h(T2)、24 h(T3)、48 h(T4)生命体征、静息和活动后VAS评分、Ramsay镇静评分、PCIA按压总次数及有效次数、患者满意度和不良反应发生情况。于T0、T1、T3和T4时采集外周静脉血(2 mL),利用FACScaliber流式细胞仪检测T细胞亚群CD3+、CD4+、CD8+的含量以及NK细胞含量,计算CD4+/CD8+比值。结果 与T0时比较,SK组在T1、T2、T3时心率显著升高(P<0.05),在T3、T4时收缩压降低(P<0.05);DK组在T2、T3、T4时心率显著降低(P<0.05),在T1、T2、T3、T4时收缩压和舒张压显著降低(P<0.05)。与SK组比较,DK组在T2、T3、T4时心率、收缩压和舒张压显著降低(P<0.05)。DK组静息状态T1、T2、T3、T4时VAS评分,活动后T1、T2时VAS评分较SK组略高(P<0.05),但2组患者术后不同时间静息VAS评分均<3分,活动后VAS评分仅在T4时>3分,镇痛效果良好。DK组患者满意度明显高于SK组(P<0.05)。2组患者术后均无镇静过度、呼吸抑制、皮肤瘙痒、消化道出血等并发症;恶心呕吐发生率DK组明显低于SK组(P<0.05)。与T0时比较SK组T1、T3、T4时CD3+、CD4+、CD4+/CD8+以及NK细胞水平降低(P<0.05);DK组T1、T3、T4时CD4+、CD4+/CD8+以及NK细胞水平降低(P<0.05)。DK组T3、T4时CD4+、CD4+/CD8+细胞水平较SK组明显升高(P<0.05)。结论 DEX联合酮咯酸氨丁三醇对胸腔镜肺癌根治术患者术后镇痛安全有效,减少阿片类药物用量,降低患者术后恶心呕吐的发生率,改善患者术后的免疫功能。

关键词: 右美托咪定, 酮咯酸氨丁三醇, 胸腔镜肺癌根治术, 镇痛, 免疫功能

Abstract: Objective To investigate the effects of dexmedetomidine-ketorolac combinations on postoperative pain and immunity in patients undergoing thoracoscopic radical resection of lung cancer. Methods Sixty patients(ASAⅠ-Ⅱ)scheduled for thoracoscopic radical resection of lung cancers were recruited and divided into two groups,to be administered(1)sufentanil 0.04 μg·kg-1·h-1 + ketorolac 3 mg/kg(SK group,n=30)or(2)dexmedetomidine 0.1 μg·kg-1·h-1 + ketorolac 3 mg/kg(DK group,n=30)for postoperative patient-controlled infusion analgesia(PCIA). Vital signs;visual analogue scale(VAS)of pain;Ramsay sedation scale before anesthesia induction(T0) and at 0 h(T1),4 h(T2),24 h(T3),and 48 h(T4)after PCIA;total and effective button pressing attempts during PCIA;patient satisfaction scores;and side effects were compared between the two groups. Levels of immune cells were also compared. Results In the DK group, hemodynamics were more stable(P<0.05). VAS scores at rest at T1,T2,T3,and T4,and VAS scores after movement at T1 and T2,and patient satisfaction scores in the DK group were relatively higher than those in the SK group(P<0.05). Incidence of nausea and vomiting were lower in the DK group than in the SK group(P<0.05). Levels of CD3+,CD4+,CD4+/CD8+,and NK cells decreased significantly in the SK group,while levels of CD4+,CD4+/CD8+,and NK cells decreased significantly in the DK group after surgery(P<0.05). Levels of CD4+,and CD4+/CD8+ cells were higher in the DK group than in the SK group(P<0.05). Conclusion Combined use of dexmedetomidine and ketorolac in PCIA can provide safe and effective analgesia,reduce opioid-related side effects,and improve the postoperative immunity of patients undergoing thoracoscopic radical resection of lung cancer.

Key words: dexmedetomidine, ketorolac, thoracoscopic radical resection of lung cancer, analgesia, immunity

中图分类号: 

  • R614
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