本文選題：地佐辛 + 術(shù)后鎮(zhèn)痛��； 參考：《臨床麻醉學(xué)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(shù)患者術(shù)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(shù)患者60例,隨機(jī)均分為地佐辛組(D組)和芬太尼組(F組),采用靜脈復(fù)合全麻,術(shù)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(shù)前(T0)、術(shù)畢(T1)、術(shù)后2h(T2)、6h(T3)、24h(T4)和48h(T5)的SBP、DBP、HR、SpO2及T1~T5時(shí)靜息時(shí)和活動(dòng)時(shí)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(yīng)。于T0、T1、T4、T5時(shí)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(xì)胞儀測定CD3+、CD4+、CD8+、CD4+/CD8+及NK細(xì)胞活性。結(jié)果兩組患者SBP、DBP、HR、SpO2、Ramsay鎮(zhèn)靜評分差異均無統(tǒng)計(jì)學(xué)意義。T2~T4時(shí)D組安靜時(shí)和活動(dòng)時(shí)VAS評分明顯低于F組(P0.05)。與T0時(shí)比較,T1時(shí)兩組E、NE、DOP水平明顯降低(P0.05或P0.01)。與T1時(shí)比較,T4、T5時(shí)兩組E、NE、DOP水平明顯升高(P0.01)。與F組比較,T4、T5時(shí)D組NE水平明顯降低(P0.05)。與T0時(shí)比較,T1、T4時(shí)D組CD3+、CD4+、CD4+/CD8+、NK細(xì)胞活性明顯降低(P0.01),T1時(shí)CD8+活性明顯升高(P0.01),T1時(shí)F組CD3+、CD4+、CD4+/CD8+、NK細(xì)胞活性和T4時(shí)CD3+、NK細(xì)胞活性,T5時(shí)NK細(xì)胞活性明顯降低(P0.05或P0.01)。與F組比較,T5時(shí)D組CD3+、CD4+、NK細(xì)胞活性明顯升高(P0.05或P0.01)。兩組患者術(shù)后48h不良反應(yīng)發(fā)生情況差異無統(tǒng)計(jì)學(xué)意義。結(jié)論地佐辛用于婦科惡性腫瘤術(shù)后鎮(zhèn)痛安全有效,與芬太尼比較鎮(zhèn)痛效果好,術(shù)后應(yīng)激反應(yīng)較輕、細(xì)胞免疫功能恢復(fù)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(shè)項(xiàng)目(ZS201204)
【分類號(hào)】：R614;R737.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 張靜;崔蘇揚(yáng);;術(shù)后鎮(zhèn)痛與免疫[J];臨床麻醉學(xué)雜志;2006年09期

2 徐建國;羅愛倫;吳新民;田玉科;岳云;王國林;俞衛(wèi)鋒;米衛(wèi)東;李天佐;馬虹;徐世元;趙國棟;卿恩明;繆長虹;石學(xué)銀;黃煥森;楊建軍;;地佐辛術(shù)后鎮(zhèn)痛專家建議[J];臨床麻醉學(xué)雜志;2013年09期

3 吳雪;劉東武;牟洪善;;μ型阿片受體研究進(jìn)展[J];生命科學(xué)儀器;2006年02期

4 李瓊珍;朱濤;;術(shù)后鎮(zhèn)痛對免疫功能的影響[J];實(shí)用醫(yī)學(xué)雜志;2010年12期

5 耿立成;李麗;馮潔;;地佐辛藥理及臨床應(yīng)用新進(jìn)展[J];醫(yī)學(xué)綜述;2012年23期

【共引文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王占東;王小玲;陳硯凝;王占紅;楊會(huì)釵;王永軍;吳國祥;;樹突狀細(xì)胞與胃間質(zhì)瘤相關(guān)性的探討[J];癌變.畸變.突變;2006年01期

2 官杰;吳艷敏;王慧;錢麗麗;李殿俊;;殼寡糖協(xié)同雙歧桿菌對荷瘤鼠免疫功能的影響[J];癌變.畸變.突變;2007年06期

3 趙成;李秀翠;王忠明;劉桂榮;;同步放化療聯(lián)合香菇多糖對晚期非小細(xì)胞肺癌患者免疫功能影響及療效的臨床研究[J];安徽醫(yī)藥;2011年11期

4 韓妙君,韓冷;高半胱氨酸膳食對小鼠生長和免疫力的影響[J];氨基酸和生物資源;2004年02期

5 李文藝;;論新型疫苗的研究概況與進(jìn)展[J];現(xiàn)代農(nóng)業(yè)科技;2009年05期

6 任保蓮;一次大運(yùn)動(dòng)量訓(xùn)練課和400m跑對女子田徑運(yùn)動(dòng)員血IgA、IgM、IgG的影響[J];北京體育大學(xué)學(xué)報(bào);2004年06期

7 陳養(yǎng)民;器官發(fā)育與程序化細(xì)胞死亡[J];寶雞文理學(xué)院學(xué)報(bào)(自然科學(xué)版);2003年01期

8 金哲;林佳靜;黃文玲;任映;于妍妍;李玲;;雌性大鼠腎虛血瘀模型初探[J];北京中醫(yī)藥;2010年09期

9 劉銳;王善玲;劉峰;張秀紅;武麗華;;甘露聚糖肽對促進(jìn)乙肝疫苗接種者抗體形成的療效觀察[J];濱州醫(yī)學(xué)院學(xué)報(bào);2006年03期

10 林治華;萬瑾;謝偉;;補(bǔ)體系統(tǒng)與腫瘤免疫[J];重慶理工大學(xué)學(xué)報(bào)(自然科學(xué)版);2010年05期

相關(guān)會(huì)議論文 前6條

1 章學(xué)林;張靜U，

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