术后静脉镇痛对肺癌手术患者围术期免疫反应及儿茶酚胺影响.docVIP

术后静脉镇痛对肺癌手术患者围术期免疫反应及儿茶酚胺影响【摘要】 目的 观察联合应用氟比洛芬酯和舒芬太尼术后静脉镇痛对肺癌手术患者围术期免疫反应及儿茶酚胺的影响。方法 选择择期行肺癌根治术患者26例,ASAⅠ-Ⅱ级,随机分为氟比洛芬酯联合舒芬太尼镇痛组(F组,n=13)和舒芬太尼镇痛组(S组,n=13)。两组患者均采用相同的异丙酚、芬太尼、维库溴铵及异氟醚静吸复合麻醉。术毕分别用氟比洛芬酯联合舒芬太尼和单纯舒芬太尼行静脉术后镇痛,采用VAS镇痛评分评价镇痛效果,并分别于于麻醉前(T0)、切皮后1 h(T1)和术毕(T2)、术后24 h(T3)、48 h(T4)检测外周血CD3、CD?4、CD?8、CD?+??23?B细胞及单核细胞HLA-DR表达的变化。同时测定外周血肾上腺素(E)、去甲肾上腺素(NE)的浓度。结果 两组术后镇痛效果无显著性差异(P0.05)。S组切皮后1 h及术毕CD3细胞下降,术后24 hCD?4细胞和CD?4/CD?8比值降低(P0.05)。结论 氟比洛芬酯联合舒芬太尼和单纯舒芬太尼术后镇痛都取得良好的镇痛效果,但前者更有利肺癌患者术后细胞免疫功能的恢复。 【关键词】 术后镇痛;氟比洛芬酯;舒芬太尼;肺肿瘤;淋巴细胞;免疫 Effect of flurbiprofen axetil combined with sufentanyl on perioperative immune response and catecholamine in patients undergoing lung cancer surgery SHI Shi-jian,ZHANG Yi-wen,XING Zu-min. Department of Anesthesiology,The First People’s Hospital of Shunde,Foshan 528300,China 【Abstract】 Objective To evaluate the effect of postoperative analgesia with flurbiprofen axetil combined with sufentanyl on perioperative immune response and catecholamine in patients undergoing lung cancer surgery. Methods Twenty-six patients ASAⅠ-Ⅱ patients aged 46-73years undergoing radical operation of lung cancer were randomly assigned into two groups: F group and S group. All patients were given identical intravenous combined with inhalational anesthesia with propofol, fentanyl, vecuronium and isoflurane. Then patients received post-operative analgesia with flurbiprofen axetil combined with sufentanyl after operation in F group, but only sufentanyl in S group. Peripheral blood CD3, CD?4, CD?8, CD?+??23?B and HLA-DR on monocyte were measured before induction of anesthesia(T1), 1 h after incision(T2), 24 h(T3) and 48 h(T4) after the completion of the surgery. Peripheral blood epinephrine(E) and norepinephrine(NE) were observed in the same time. Results There was no significant difference in visual analogue scale (VAS) between F group and S group. In CD3% decreased at T2 and CD?4%, CD?4/CD?8 ratio decreased at T3 in the group S, but not in the group F. CD?4/CD?8