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目的:探讨舒芬太尼硬膜外超前镇痛应用于乳腺癌改良根治术患者的镇痛效果及对免疫功能的影响。方法:60例乳腺癌患者随机分为超前镇痛组和对照组。两组患者均采用气管插管全身麻醉,超前镇痛组在手术开始前30 min硬膜外注射舒芬太尼0.2μg·kg~(-1),对照组同时注射等量0.9%氯化钠注射液。分别于麻醉诱导前(T_0)、术后30 min(T_(0.5_)、4 h(T_4)、24h(T_(24))测量患者血浆T细胞亚群(CD3、CD4、CD8)及白细胞介素(IL-2、IL-6、IL-10)水平,同时比较两组患者术后拔管清醒后各时间点的疼痛情况。结果:超前镇痛组患者术后各时间点疼痛评分均低于对照组(P<0.05)。超前镇痛组患者CD3、CD4、CD8与IL-2、IL-6、IL-10在T_(0.5)、T_4、T_(24)时与T_0比较,差异无统计学意义(P>0.05),对照组CD3、CD4、CD8与IL-2在T_(0.5)、T_4、T_(24)时较T_0时明显减少,而IL-6、IL-10明显增多(P<0.05或0.01)。结论:舒芬太尼硬膜外超前镇痛应用于乳腺癌改良根治术患者能取得较好的镇痛效果,同时能够保护患者免疫功能,抑制应激反应,减轻手术及麻醉对患者免疫功能的抑制作用。
Objective: To investigate the effect of preemptive epidural analgesia with sufentanil on the analgesic effect and immune function of patients undergoing modified radical mastectomy. Methods: 60 breast cancer patients were randomly divided into preemptive analgesia group and control group. Both groups received general anesthesia with endotracheal intubation. In the preemptive analgesia group, sufentanil 0.2 μg·kg -1 was injected epidurally 30 min before the start of surgery. The control group received 0.9% sodium chloride equivalent at the same time. Injection. T-cell subsets (CD3, CD4, and CD8) and leukocyte counts were measured before induction of anesthesia (T_0), 30 min (T_(0.5_), 4 h (T_4), and 24 h (T24)). Levels of IL-2, IL-6, and IL-10 were compared at the same time after the extubation was awake at each time point.Results: Patients in the preemptive analgesia group had low pain scores at various time points after surgery. In the control group (P<0.05), the differences in CD3, CD4, CD8 and IL-2, IL-6, IL-10 in patients with preemptive analgesia between T_(0.5), T_4, T_(24) and T_0 were not significant. Statistical significance (P>0.05). In the control group, CD3, CD4, CD8 and IL-2 were significantly decreased at T_(0.5), T_4, T_(24) compared with T_0, while IL-6 and IL-10 were significantly increased ( P <0.05 or 0.01. Conclusion: Sufentanil epidural preemptive analgesia can achieve better analgesia in patients undergoing modified radical mastectomy for breast cancer, and can protect the patient’s immune function, inhibit stress response, and reduce the risk of surgery. And anesthesia inhibits the immune function of patients.