發(fā)布時(shí)間：2018-04-13 14:09

  本文選題：舒芬太尼 + 靶控鎮(zhèn)痛�。� 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:觀察舒芬太尼靶控鎮(zhèn)痛對(duì)腹腔鏡術(shù)后患者的免疫功能以及相關(guān)介質(zhì)的影響,為靶控鎮(zhèn)痛應(yīng)用于臨床提供參考。方法:30例罹患下腹部惡性腫瘤疾病患者,擇期在腹腔鏡下行根治術(shù),美國(guó)麻醉醫(yī)師協(xié)會(huì)分級(jí)ASA I~II級(jí),年齡45~65歲,隨機(jī)分為2組,使用舒芬太尼術(shù)后鎮(zhèn)痛,A組(靜脈靶控鎮(zhèn)痛組)15例:啟始血漿靶濃度0.1ng/ml,Prince-Henry評(píng)分3分時(shí)上調(diào)靶濃度,每一次上調(diào)0.01ng/ml,鎖定15min。B組(傳統(tǒng)靜脈鎮(zhèn)痛組)15例:背景劑量3μg/h,Prince-Henry評(píng)分3分時(shí)PCA予3μg/次,鎖定15min。異丙酚和舒芬太尼術(shù)中持續(xù)靜脈靶控輸注,氣管導(dǎo)管拔除后于Prince-Henry評(píng)分3分,Ramsay鎮(zhèn)靜評(píng)分2分時(shí)上術(shù)后鎮(zhèn)痛泵,在鎮(zhèn)痛前(T0)及上鎮(zhèn)痛泵時(shí)(T1)、上鎮(zhèn)痛泵后1h(T2)、2h(T3)、4h(T4)、8h(T5)、和16h(T6)記錄T1-T6時(shí)點(diǎn)Prince-Henry鎮(zhèn)痛評(píng)分、Ramsay鎮(zhèn)靜評(píng)分、生命體征及術(shù)中、術(shù)后舒芬太尼總用藥量和不良反應(yīng)發(fā)生情況;兩組患者均在麻醉誘導(dǎo)前、T0、T4、T6各時(shí)點(diǎn)采血,ELISA檢測(cè)血漿P物質(zhì)、β內(nèi)啡肽的濃度,并于麻醉誘導(dǎo)前、T0、T6時(shí)點(diǎn)測(cè)定血中CD4+、CD8+、CD4+/CD8+T淋巴細(xì)胞亞群水平。結(jié)果:(1)兩組患者各時(shí)點(diǎn)DBP、SBP、HR、RR、Sp O2比較無(wú)明顯差異(P0.05)。(2)在T2、T5、T6時(shí)點(diǎn),B組Prince-Henry評(píng)分顯著高于A組(P0.05)。(3)術(shù)后鎮(zhèn)痛16h舒芬太尼的用藥量A組高于B組(P0.05)。(4)在T6時(shí)點(diǎn),A組患者P物質(zhì)濃度低于B組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);與麻醉前比較,A、B組P物質(zhì)濃度在T0、T4時(shí)點(diǎn)上升(P0.05)。(5)術(shù)后A、B組間的各時(shí)點(diǎn)β內(nèi)啡肽濃度比較均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),與麻醉前比較,A、B組β內(nèi)啡肽濃度在T0、T4、T6時(shí)點(diǎn)升高(P0.05)。(6)A、B組間患者的CD4+、CD8+、CD4+/CD8+淋巴細(xì)胞亞群水平比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);與麻醉前相比,兩組患者CD4+淋巴細(xì)胞亞群在T0、T6時(shí)點(diǎn)下降(P0.05)。結(jié)論:腹腔鏡下腹部惡性腫瘤根治術(shù)患者術(shù)后使用舒芬太尼靶控鎮(zhèn)痛,患者血漿中P物質(zhì)濃度降低,β內(nèi)啡肽的含量升高不明顯,可減輕術(shù)后應(yīng)激反應(yīng);使術(shù)后早期患者CD4+淋巴細(xì)胞輕度減少,對(duì)CD8+、CD4+/CD8+淋巴細(xì)胞亞群影響不大;且在不增加副作用的情況下具備更完善的鎮(zhèn)痛。
[Abstract]:Objective: to observe the effect of sufentanil target controlled analgesia on immune function and related mediums in patients undergoing laparoscopic surgery, and to provide reference for clinical application of target controlled analgesia.Methods Thirty patients with malignant tumors of lower abdomen were randomly divided into two groups. The patients underwent laparoscopic radical mastectomy. The American Society of Anesthesiologists graded ASA I~II, aged 45 to 65 years, and were randomly divided into two groups.Sufentanil was used for postoperative analgesia in group A (15 cases of intravenous target controlled analgesia group: initial plasma target concentration was 0.1 ng / ml) and the target concentration was up-regulated at 3 min after injection of sufentanil.Each time 0.01 ng / ml was upregulated, and the 15min.B group was locked (15 cases in the traditional intravenous analgesia group: PCA was given 3 渭 g / time at 3 渭 g / h Princeton Henry score at the background dose of 3 渭 g / L and locked for 15 min).Propofol and sufentanil were continuously injected intraoperatively with target controlled infusion, and the postoperative analgesia pump was put on at the time of Prince-Henry score of 3 and Ramsay sedation score of 2 points after tracheal catheter extubation.Plasma substance P and 尾 endorphin levels were detected by Elisa at each time point before anesthesia induction, and the levels of CD4 / CD8 T lymphocyte subsets of CD4 / CD8 + T _ 4 / CD _ 8 were measured at T _ 0 / T _ 6 before anesthesia induction.There was no significant difference in the levels of CD4 / CD8 lymphocyte subsets between CD4 / CD8 and CD _ 4 / CD _ 8 groups in patients with T0 / T _ 4 / T _ 6, compared with those before anesthesia, compared with before anesthesia, there was no significant difference in the level of CD4 / CD8 lymphocyte subsets between the two groups.The CD4 lymphocyte subsets in both groups decreased at T 0 T 6 (P 0 05).Conclusion: sufentanil was used in patients undergoing laparoscopic radical operation for abdominal malignant tumor. The plasma concentration of substance P was decreased and the content of 尾 -endorphin was not significantly increased, which could alleviate the stress response after operation.At the early stage of operation, CD4 lymphocytes were slightly decreased, but the CD4 / CD8 subsets of CD8 were not significantly affected, and the analgesia was improved without increasing side effects.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614

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