靜脈鎮(zhèn)痛論文：瑞芬太尼術(shù)后鎮(zhèn)痛對胃癌患者T細(xì)胞亞群的影響

1、靜脈鎮(zhèn)痛論文：瑞芬太尼術(shù)后鎮(zhèn)痛對胃癌患者T細(xì)胞亞群的影響【中文摘要】比較術(shù)后鎮(zhèn)痛及不同藥物靜脈鎮(zhèn)痛對胃癌患者術(shù)后T細(xì)胞亞群的影響。方法：選擇2009年6月-12月在我院胃腸科行胃癌根治術(shù)的60例符合篩選條件患者為研究對象,隨機(jī)分為三組,每組20例,R組為瑞芬太尼靜脈鎮(zhèn)痛組,F組為芬太尼靜脈鎮(zhèn)痛組。T組為未行術(shù)后鎮(zhèn)痛組(對照組。其中R組鎮(zhèn)痛泵配方為瑞芬太尼0.02mg/kg+昂丹司瓊8mg+0.9%生理鹽水稀釋100ml,F組鎮(zhèn)痛泵配方為芬太尼0.02mg/kg+昂丹司瓊8mg+0.9%生理鹽水稀釋至100ml。鎮(zhèn)痛組均在患者拔管后行鎮(zhèn)痛治療,首次量2m1,連續(xù)背景輸注劑量2m1/h,單次給藥劑

2、量2 ml/次,鎖定時(shí)間15min。三組患者都接受相同的氣管插管、靜吸復(fù)合麻醉。分別于麻醉前、術(shù)后24h、術(shù)后48h、術(shù)后72h測定患者T細(xì)胞亞群的變化。三組患者術(shù)后4h、24h、48h進(jìn)行視覺模擬評分及不良反應(yīng)記錄。結(jié)果：1、三組患者一般情況比較差異無統(tǒng)計(jì)學(xué)意義(P>0.052、未行鎮(zhèn)痛與鎮(zhèn)痛組各時(shí)點(diǎn)VAS評分比較差異有統(tǒng)計(jì)學(xué)意義(P0.05。3、三組患者CD3+.CD4+.CD8+.CD4+/CD8+術(shù)后24h均較麻醉前降低。其中CD3+.CD4+.CD4+/CD8+降低與麻醉前對比差異有統(tǒng)計(jì)學(xué)意義(P<0.05。4、在術(shù)后48h瑞芬太尼組CD3+.CD4+.CD4+/CD8+

3、已恢復(fù)到麻醉前水平,而芬太尼組及未行術(shù)后鎮(zhèn)痛組上述指標(biāo)仍降低,組間比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05。5、術(shù)后72h鎮(zhèn)痛組患者CD3+.CD4+.CD8+.CD4+/CD8+指標(biāo)均恢復(fù)至麻醉前水平,而未行鎮(zhèn)痛組上述指標(biāo)仍降低,組間比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05。結(jié)論：術(shù)后良好的靜脈鎮(zhèn)痛能抑制術(shù)后疼痛對機(jī)體細(xì)胞免疫功能的影響,瑞芬太尼術(shù)后靜脈鎮(zhèn)痛較芬太尼能減輕胃癌根治術(shù)患者術(shù)后細(xì)胞免疫抑制,對機(jī)體細(xì)胞免疫功能有一定的保護(hù)作用,是一種有效的、可用于胃癌根治術(shù)患者鎮(zhèn)痛的一種方法?！居⑽恼?To investigate the effects of PCIA with differ

4、ent durgs on the changes of T-Iymphocyte subsets in patients with gastric cancer after radical operation.Method:Sixty patients underwent radical operation of gastric cancer were randomly assigned into three groups:Remifentanil group(R Group,Fentanil group (F groupand not accepted the analgesia treat

5、ment group(T Group.All patients were given identical Intravenous-inhalation combined anesthesia.Then patients received postoperative analgesia with Remifentanil after operation in R group,the patients in F group were received post-operative analgesia with fentanil,T Group did not accepted the analge

6、sia treatment.Peripheral blood samples were obtained before anesthesia,after operation for 24h,48h,and72h,respectively.The T-lymphocyte subsets was measured by flow cytometry.The analgesic was evaluated by Visual Analogue scale (VAS on different times after operations.Result:Firstly, for common situ

7、ation among three groups, doesnt have significant difference (P>0.05;Secondly, VAS has significant difference in analgesia treatment group and not accept analgesia treatment group (P0.05;Thirdly,among three groups,the amount of CD3+、CD4+、CD8+、CD4+/CD8+ lymphocyte significantly decreased after ope

8、ration for 24h than that before operation(P<0.05;Fourthly,in R group, after operation for 48h the amount of CD3+、CD4+、CD4+/CD8+lymphocyte were recovered nearly to the level before operation, but in F group the amount of CD3+、CD4+、CD8+.CD4+/CD8+lymphocyte were lower than the level before operation

9、. There were significant differences between the two groups(P<0.05;Fifthly,both in the groups after operation for 72h,the amount of CD3+、CD4+、 CD8+、CD4+/CD8+ recovered to the level before operation.Conclusions:Posoperative analgesia with Remifentanil or with fentanil shows a similar postoperative

10、 analgesic effect in patients underwent radical operation of gastric cancer,but the remifentanil contributes more to recover cellmediated immunity of the patients suffering excision of gastric cancer.【關(guān)鍵詞】靜脈鎮(zhèn)痛 胃癌根治術(shù) T細(xì)胞亞群 免疫 瑞芬太尼【英文關(guān)鍵詞】postoperative analgesia T-lymphocyte gastric cancer immunity【目錄】

11、瑞芬太尼術(shù)后鎮(zhèn)痛對胃癌患者T細(xì)胞亞群的影響摘要3-5ABSTRACT5-6英文縮寫9-10第1章 前言10-12第2章 材料和方法12-172.1 試驗(yàn)方法12-142.1.1 病例選擇及分組12-132.1.2 麻醉方法132.1.3 鎮(zhèn)痛方法132.1.4 主要藥品13-142.1.5 儀器142.2 觀察指標(biāo)及標(biāo)本采集142.2.1 VAS評分142.2.2 標(biāo)本收集與處理142.3 檢測方法14-162.3.1 T細(xì)胞亞群檢測14-162.4 統(tǒng)計(jì)學(xué)方法16-17第3章 結(jié)果17-213.1 兩組患者一般情況的比較173.2 鎮(zhèn)痛評分17-183.3 不良反應(yīng)183.4 三組患者各時(shí)點(diǎn)T細(xì)胞亞群變化比較18-21第4章 討論21-294.1 圍手術(shù)期影響患者免疫功能的因素22-234.2 術(shù)后疼痛對機(jī)體免疫