天津医药

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舒芬太尼联合氟比洛芬酯自控静脉镇痛对胆囊切除术后患者T细胞亚群的影响

杜津1,陈政1,王国林2   

  1. 1. 解放军第254医院
    2. 天津医大总医院
  • 收稿日期:2010-05-26 修回日期:2010-12-15 出版日期:2011-04-15 发布日期:2011-04-15
  • 通讯作者: 杜津

A comparison of effects of postoperative analgesia with sufentanil or flurbiprofen on cellular immune function

  • Received:2010-05-26 Revised:2010-12-15 Published:2011-04-15 Online:2011-04-15

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摘要： 摘 要：目的 比较不同剂量舒芬太尼和氟比洛芬酯对胆囊结石病人术后镇痛效果及免疫功能的影响。 方法 45例胆囊择期手术的病人术后镇痛，予舒芬太尼和氟比洛芬酯静脉持续输注，随机分成三组，每组15例。Ⅰ组为舒芬太尼2ug/ml进行镇痛；Ⅱ组为氟比洛芬酯1mg/ml＋舒芬太尼0.75ug/ml镇痛；Ⅲ组为氟比洛芬酯1mg/ml＋舒芬太尼0.50ug/ml镇痛。分别在术后4、24、48h观察病人的镇痛效果、镇痛评分（VAS法）；并且在麻醉前、术后1、24、72h抽取静脉血，用流式细胞仪测定T细胞亚群。结果 Ⅲ组镇痛效果不完善，VAS评分明显高于Ⅰ、Ⅱ组(P﹤0.05)，Ⅰ组和Ⅱ组镇痛良好。三组病人术后1、24h与麻醉前相比体内CD3+、CD4+细胞数量及CD4+/CD8+比值均明显下降（P﹤0.05），Ⅰ组下降最显著；术后48hⅡ组和Ⅲ组均恢复至术前水平，Ⅰ组仍低于术前水平。结论 三组对比，Ⅲ组镇痛效果不理想；Ⅰ组术后一过性免疫抑制的程度最明显；Ⅱ组既可取得良好的镇痛效果，术后引起的免疫抑制程度又相对较轻，因此建议采用氟比洛芬酯1mg/ml＋舒芬太尼0.75ug/ml术后静脉镇痛最为安全可靠。

关键词: 镇痛, 舒芬太尼, 氟比洛芬, 免疫功能

Abstract: Abstract：Objective To compare the effects of postoperative analgesia with sufentanil or flurbiprofen on cellular immune function. Methods Forty-five ASA ⅠorⅡ patients undergoing cholecystectomy were randomly divided into three groups with 15cases each: groupⅠPCIA with sufentanil 2ug/ml; groupⅡ PCIA with sufentanil 0.75ug/ml+flurbiprofen 1mg/ml and groupⅢ PCIA with sufentanil 0.5ug/ml+flurbiprofen 1mg/ml. PCIA was started with background infusion rate 2 ml/h, blouse dose 0.5ml, lockout interval 5 min. VAS scores were measured at 4,24h and 48h after operation respectively. Blood samples were obtained from peripheral vein at before operation, and at 1,24,72h after operation for determination of the plasma levels of CD3+、CD4+ and CD8+ in lymphocyte. CD4+ /CD8+ ratio was calculated. Results VAS scores of groupⅢ were markedly higher than that of groupⅠand groupⅡin postoperative 4,24h and 48h (P<0.05). Before anesthesia, there were no significant difference in T Lymphocytic cell subpopulation (CD3+,CD4+,CD8+,CD4+/D8+), among three groups(P>0.05). The level of CD3+,CD4+ and CD4+/D8+ were all decreased at postoperative 1h and 24h in three groups compared with baseline value, while the level of CD3+,CD4+ and CD4+/D8+ in groupⅡand groupⅢ were increased compare with groupⅠ(P<0.05). Conclusions Flurbiprofen can improve the cellular immune function in the patients after cholecystectomy through reducing the consumption of sufentanil for PCIA.

Key words: Analgesia, Sufentanil, Flurbiprofen, Immune function