静脉镇痛论文：瑞芬太尼术后镇痛对胃癌患者T细胞亚群的影响

1、静脉镇痛论文：瑞芬太尼术后镇痛对胃癌患者T细胞亚群的影响【中文摘要】比较术后镇痛及不同药物静脉镇痛对胃癌患者术后T细胞亚群的影响。方法：选择2009年6月-12月在我院胃肠科行胃癌根治术的60例符合筛选条件患者为研究对象,随机分为三组,每组20例,R组为瑞芬太尼静脉镇痛组,F组为芬太尼静脉镇痛组。T组为未行术后镇痛组(对照组。其中R组镇痛泵配方为瑞芬太尼0.02mg/kg+昂丹司琼8mg+0.9%生理盐水稀释100ml,F组镇痛泵配方为芬太尼0.02mg/kg+昂丹司琼8mg+0.9%生理盐水稀释至100ml。镇痛组均在患者拔管后行镇痛治疗,首次量2m1,连续背景输注剂量2m1/h,单次给药剂

2、量2 ml/次,锁定时间15min。三组患者都接受相同的气管插管、静吸复合麻醉。分别于麻醉前、术后24h、术后48h、术后72h测定患者T细胞亚群的变化。三组患者术后4h、24h、48h进行视觉模拟评分及不良反应记录。结果：1、三组患者一般情况比较差异无统计学意义(P>0.052、未行镇痛与镇痛组各时点VAS评分比较差异有统计学意义(P0.05。3、三组患者CD3+.CD4+.CD8+.CD4+/CD8+术后24h均较麻醉前降低。其中CD3+.CD4+.CD4+/CD8+降低与麻醉前对比差异有统计学意义(P<0.05。4、在术后48h瑞芬太尼组CD3+.CD4+.CD4+/CD8+

3、已恢复到麻醉前水平,而芬太尼组及未行术后镇痛组上述指标仍降低,组间比较差异有统计学意义(P<0.05。5、术后72h镇痛组患者CD3+.CD4+.CD8+.CD4+/CD8+指标均恢复至麻醉前水平,而未行镇痛组上述指标仍降低,组间比较差异有统计学意义(P<0.05。结论：术后良好的静脉镇痛能抑制术后疼痛对机体细胞免疫功能的影响,瑞芬太尼术后静脉镇痛较芬太尼能减轻胃癌根治术患者术后细胞免疫抑制,对机体细胞免疫功能有一定的保护作用,是一种有效的、可用于胃癌根治术患者镇痛的一种方法。【英文摘要】: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.【关键词】静脉镇痛 胃癌根治术 T细胞亚群 免疫 瑞芬太尼【英文关键词】postoperative analgesia T-lymphocyte gastric cancer immunity【目录】

11、瑞芬太尼术后镇痛对胃癌患者T细胞亚群的影响摘要3-5ABSTRACT5-6英文缩写9-10第1章 前言10-12第2章 材料和方法12-172.1 试验方法12-142.1.1 病例选择及分组12-132.1.2 麻醉方法132.1.3 镇痛方法132.1.4 主要药品13-142.1.5 仪器142.2 观察指标及标本采集142.2.1 VAS评分142.2.2 标本收集与处理142.3 检测方法14-162.3.1 T细胞亚群检测14-162.4 统计学方法16-17第3章 结果17-213.1 两组患者一般情况的比较173.2 镇痛评分17-183.3 不良反应183.4 三组患者各时点T细胞亚群变化比较18-21第4章 讨论21-294.1 围手术期影响患者免疫功能的因素22-234.2 术后疼痛对机体免疫