本文選題：地佐辛 + 術后鎮(zhèn)痛�。� 參考：《臨床麻醉學雜志》2015年09期

【摘要】：目的觀察地佐辛用于婦科惡性腫瘤手術患者術后鎮(zhèn)痛的效果及對血漿兒茶酚胺和免疫功能的影響。方法擇期行婦科惡性腫瘤手術患者60例,隨機均分為地佐辛組(D組)和芬太尼組(F組),采用靜脈復合全麻,術畢使用患者靜脈自控鎮(zhèn)痛(PCIA),D組PCIA配方為地佐辛0.8mg/kg加托烷司瓊6mg加生理鹽水配至100ml,F組PCIA配方為芬太尼0.01mg/kg加托烷司瓊6mg加生理鹽水配至100ml。記錄患者術前(T0)、術畢(T1)、術后2h(T2)、6h(T3)、24h(T4)和48h(T5)的SBP、DBP、HR、SpO2及T1~T5時靜息時和活動時VAS疼痛評分、Ramsay鎮(zhèn)靜評分及惡心、嘔吐、低血壓、呼吸抑制等不良反應。于T0、T1、T4、T5時抽取靜脈血4 ml,其中2 ml采用ELISA法測定血漿腎上腺素(E)、去甲腎上腺素(NE)、多巴胺(DOP)水平,剩余2ml采用流式細胞儀測定CD3+、CD4+、CD8+、CD4+/CD8+及NK細胞活性。結果兩組患者SBP、DBP、HR、SpO2、Ramsay鎮(zhèn)靜評分差異均無統(tǒng)計學意義。T2~T4時D組安靜時和活動時VAS評分明顯低于F組(P0.05)。與T0時比較,T1時兩組E、NE、DOP水平明顯降低(P0.05或P0.01)。與T1時比較,T4、T5時兩組E、NE、DOP水平明顯升高(P0.01)。與F組比較,T4、T5時D組NE水平明顯降低(P0.05)。與T0時比較,T1、T4時D組CD3+、CD4+、CD4+/CD8+、NK細胞活性明顯降低(P0.01),T1時CD8+活性明顯升高(P0.01),T1時F組CD3+、CD4+、CD4+/CD8+、NK細胞活性和T4時CD3+、NK細胞活性,T5時NK細胞活性明顯降低(P0.05或P0.01)。與F組比較,T5時D組CD3+、CD4+、NK細胞活性明顯升高(P0.05或P0.01)。兩組患者術后48h不良反應發(fā)生情況差異無統(tǒng)計學意義。結論地佐辛用于婦科惡性腫瘤術后鎮(zhèn)痛安全有效,與芬太尼比較鎮(zhèn)痛效果好,術后應激反應較輕、細胞免疫功能恢復更快。
[Abstract]:Objective to observe the effect of dizosin on postoperative analgesia and plasma catecholamine and immune function in patients with gynecological malignant tumor. Methods Sixty patients with gynecological malignant tumor were randomly divided into two groups: group D (group D) and group F (group F). The PCIA formula of group D was dizosin 0.8mg/kg plus tropisetron 6mg plus normal saline after operation, and that of group F was fentanyl 0.01mg/kg plus troponisetron 6mg plus normal saline to 100ml. The adverse reactions such as preoperative T0, T1, 6hT3, 24 hT4 and 48h T5) were recorded. The scores of VAS pain at rest and during T1~T5, including sedation score, nausea, vomiting, hypotension, respiratory depression and so on, were also recorded. Venous blood was collected at T0 T _ 1 T _ 4 T _ 4 T _ 5, 2 ml of which was measured by ELISA method for plasma epinephrine, norepinephrine (NE), dopamine dop (DOP), and the remaining 2ml was measured by flow cytometry (FCM) to determine the CD4 / CD8 and NK cell activity of CD3. Results there was no significant difference in the sedation score between the two groups. The VAS score of group D was significantly lower than that of group F (P 0.05) at rest and activity at T _ 2 / T _ 4. Compared with T0, the DOP level of EMA in both groups was significantly lower than that at T0 (P 0.05 or P 0.01). Compared with T1, the DOP level of Eneo in T4 + T5 group was significantly higher than that in T4 + T5 group. Compared with group F, NE level in group D was significantly lower than that in group F at T4 and T5. Compared with that at T0, the activity of CD4 / CD8 / CD8 NK cells in group D was significantly lower than that in group D at T0 / T4. The activity of CD8 was significantly increased in group F at P0.01T 1 and that in CD3 CD4 / CD8 + T 5 in group T 4 and in group T 5. The activity of NK cells in T 5 or T 4 was significantly decreased by P0.05 or P0.01T 1, compared with that in group D at T 1 and T 4. The activity of CD 4 / CD 8 + NK cells in T 1 group was significantly lower than that in T 1 group (P 0. 01). Compared with group F, the NK cell activity of CD3 in group D was significantly higher than that in group F (P 0.05 or P 0.01). There was no significant difference between the two groups in the incidence of adverse reactions 48 hours after operation. Conclusion Dizosin is safe and effective in postoperative analgesia for gynecological malignant tumors. Compared with fentanyl, it has better analgesic effect, less stress response and faster recovery of cellular immune function.
【作者單位】： 江蘇省腫瘤醫(yī)院麻醉科;
【基金】：江蘇省腫瘤醫(yī)院科研基金�？平ㄔO項目(ZS201204)
【分類號】：R614;R737.3

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