本文選題：右美托咪啶　切入點：嗎啡　出處：《福建醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的觀察右美托咪啶聯(lián)合嗎啡靜脈自控鎮(zhèn)痛對食管癌患者根治術后外周血T淋巴細胞亞群（CD3+、CD4+、CD8+、CD4+/CD8+）以及自然殺傷細胞（NK細胞）的影響。 方法選擇食管癌根治術患者60例，ASAⅠ～Ⅱ級，年齡40～60歲，采用隨機數(shù)字表法，隨機分為嗎啡鎮(zhèn)痛組（M組，n=30）和右美托咪啶聯(lián)合嗎啡鎮(zhèn)痛組（DM組，n=30）。于手術結束即刻行病人自控靜脈鎮(zhèn)痛，M組采用嗎啡0.02mg/kg/h，DM組采用嗎啡0.02mg/kg/h+右美托咪啶1ug/kg/d,均用生理鹽水稀釋至150ml。術后24h、48h、72h采用視覺模擬評分法(VAS評分）評價鎮(zhèn)痛效果；記錄鎮(zhèn)痛期間內(nèi)的嗎啡用量、PCA總次數(shù)和有效按壓次數(shù)；并記錄在此期間惡心嘔吐、瘙癢、心動過緩、低血壓、鎮(zhèn)靜過度、呼吸抑制等不良反應的發(fā)生率。于麻醉誘導前、拔管即刻、術后24h、48h、72h測定CD3+、CD4+、CD8+、CD4+/CD8+及NK細胞的表達水平。 結果兩組患者術后VAS評分比較差異無統(tǒng)計學意義(P0.05)；鎮(zhèn)痛期間兩組患者均未發(fā)生心動過緩、低血壓、過度鎮(zhèn)靜和呼吸抑制等不良反應。與M組比較，DM組術后24h、48h、72h內(nèi)嗎啡用量、PCA總按壓次數(shù)和有效按壓次數(shù)降低，術后惡心嘔吐及瘙癢的發(fā)生率也降低(P0.05)。與各自相應的麻醉前基礎值相比，兩組患者的CD3+、CD4+、CD4+/CD8+值于拔管即刻開始下降，術后24h最低，術后48，72h內(nèi)逐漸恢復，差異有統(tǒng)計學意義(P 0.05)；兩組患者的NK細胞在拔管即刻、術后24h、48h、72h也比麻醉前降低(P 0.05)；而各時間點組內(nèi)或組間的CD8+值相比較，差異無統(tǒng)計學意義(P0.05)。與M組相比，DM組在術后24h、48h、72h內(nèi)CD3+、CD4+、CD4+/CD8+及NK值下降幅度較小，，差異有統(tǒng)計學意義(P 0.05)。 結論與M組靜脈鎮(zhèn)痛相比，食管癌根治術后患者采用DM組，在相同的鎮(zhèn)痛效果基礎上可減少嗎啡用量，降低不良反應發(fā)生率。DM組能更有效地食道癌術后患者T淋巴細胞亞群（CD3+、CD4+、CD4+/CD8+）和NK細胞的抑制,對機體細胞免疫功能有一定的保護作用,更有利于食管癌患者術后細胞免疫功能的恢復。
[Abstract]:Objective To observe the effect of dexmedetomidine combined with morphine intravenous analgesia on peripheral blood T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) and natural killer cells (NK cells) in patients with esophageal cancer after radical operation.
Methods 60 cases of patients with esophageal cancer radical surgery, ASA I-II, age 40~60 years, were randomly divided into morphine analgesia group (group M, n=30) and dexmedetomidine combined with morphine analgesia group (group DM, n=30). At the end of the patient-controlled intravenous analgesia for surgery 0.02mg/kg/h, M group with DM group with morphine, morphine 0.02mg/kg/h+ dexmedetomidine 1ug/kg/d, were diluted with saline to 150ml. after 24h, 48h, 72h by using visual analogue scale (VAS score) to evaluate the analgesic effect of morphine analgesia; recorded during dosage, times of PCA and effective pressing numbers; and on this record during the period of nausea and vomiting, pruritus, bradycardia, hypotension, excessive sedation, the incidence of respiratory depression and other adverse reactions. Before induction of anesthesia, extubation, postoperative 24h, 48h, 72h, CD4+, CD8+, CD3+ were measured, the expression level of CD4+/CD8+ and NK cells.
緇撴灉涓ょ粍鎮(zhèn)ｈ

本文編號：1616870