【摘要】：目的探討右美托咪定復(fù)合嗎啡PCIA用于開(kāi)胸手術(shù)術(shù)后鎮(zhèn)痛對(duì)機(jī)體免疫細(xì)胞的影響。方法選擇2012年3月至2014年4月在我院行開(kāi)胸手術(shù)的患者112例,男53例,女59例,年齡41~60歲,ASAⅠ或Ⅱ級(jí),隨機(jī)分為復(fù)合組和嗎啡組,其中,復(fù)合組51例,男26例,女25例,嗎啡組61例,男27例,女34例,術(shù)畢蘇醒、氣管導(dǎo)管拔除后,主訴疼痛者(VAS評(píng)分4分)行PCIA。PCIA給藥方案:復(fù)合組患者給予含1.0μg/kg右美托咪定和0.48mg/kg嗎啡的藥液150ml,嗎啡組患者則給予含0.48mg/kg嗎啡的藥液150 ml,負(fù)荷量2 ml,背景輸注速率2 ml/h,鎖定時(shí)間15min,維持術(shù)后疼痛VAS評(píng)分≤3分。分別于麻醉誘導(dǎo)前(T0)、氣管導(dǎo)管拔除即刻(T1)、術(shù)后12h(T2)、術(shù)后24h(T3)、術(shù)后48h(T4)、術(shù)后72h(T5)及術(shù)后7d(T6),利用FACSCalibur流式細(xì)胞儀對(duì)外周血中CD3+、CD4+、CD8+淋巴細(xì)胞亞群及NK細(xì)胞含量進(jìn)行檢測(cè),并計(jì)算CD4+/CD8+值,記錄T3~T5時(shí)的嗎啡用量,術(shù)后7d患者不良反應(yīng)發(fā)生情況。結(jié)果復(fù)合組患者術(shù)后T2~T5時(shí)VAS評(píng)分均明顯低于嗎啡組(P0.05),復(fù)合組患者術(shù)后T3~T5時(shí)嗎啡用量均明顯低于嗎啡組(P0.05);復(fù)合組患者術(shù)后瘙癢、惡心和嘔吐發(fā)生率均明顯低于嗎啡組(P0.05);與T0時(shí)比較,兩組患者T1~T5時(shí)CD3+、CD4+、CD4+/CD8+和NK細(xì)胞水平均降低。復(fù)合組患者T2~T5時(shí)CD3+水平和CD4+/CD8+均明顯高于嗎啡組,復(fù)合組患者T3~T5時(shí)CD4+和NK細(xì)胞水平均明顯高于嗎啡組(P0.05)。結(jié)論右美托咪定復(fù)合嗎啡PCIA用于開(kāi)胸手術(shù)術(shù)后鎮(zhèn)痛可有效減少嗎啡用量,降低鎮(zhèn)痛時(shí)不良反應(yīng)發(fā)生,改善患者細(xì)胞免疫功能。
[Abstract]:Objective to investigate the effect of dexmetomidine combined with morphine PCIA on immune cells after thoracotomy. Methods from March 2012 to April 2014, 112 patients (53 males and 59 females, aged 41 to 60 years) undergoing thoracotomy in our hospital were randomly divided into compound group (n = 51) and morphine group (n = 25), including compound group (n = 51), male group (n = 26) and female group (n = 25). In morphine group, 61 cases (27 males and 34 females) recovered after operation and tracheal catheter was removed. Patients who complained of pain (VAS score 4) were given PCIA.PCIA regimen: patients in the compound group were given 150 ml of drug containing 1.0 渭 g/kg dexmetidine and 0.48mg/kg morphine, while patients in the morphine group were given 150 ml, load of 150 ml, containing 0.48mg/kg morphine, 2 ml, background infusion rate 2 ml/h,. The locking time was 15 min and the VAS score of postoperative pain was 鈮，

本文編號(hào)：2292820