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| 纳布啡复合舒芬太尼对肝切除术后患者免疫功能的影响 |
| Effect of combined application of nalbuphine and sufentanil with postoperative analgesia on immune function of patients undergoing hepatectomy |
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| DOI：10.12089/jca.2021.08.001 |
| 中文关键词: 纳布啡 肝切除术 T淋巴细胞亚群 补体 免疫功能 |
| 英文关键词: Nalbuphine Hepatectomy T lymphocyte subsets Immune function |
| 基金项目:湖北陈孝平科技发展基金会资助项目（CXPJJH118000017-02-07） |
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| 中文摘要: |
目的 探讨纳布啡复合舒芬太尼应用于肝切除术患者术后镇痛对免疫功能的影响。
方法 选择2018年9月至2020年12月拟行开腹左半肝切除术的肝癌患者120例，男65例，女55例，年龄18～64岁，BMI 18～25 kg/m2，ASA Ⅰ或Ⅱ级，TNM Ⅰ或Ⅱ期。采用随机数字表法将患者分为三组：舒芬太尼组（S组，n=38）、纳布啡组（N组，n=42）和纳布啡复合舒芬太尼组（NS组，n=40）。所有患者均给予常规麻醉处理。S组，舒芬太尼2.5 μg/kg+托烷司琼10 mg+生理盐水100 ml行术后静脉自控镇痛(PCIA)；N组，纳布啡2 mg/kg+托烷司琼10 mg+生理盐水100 ml行术后PCIA；NS组，纳布啡1 mg/kg+舒芬太尼1.25 μg/kg+托烷司琼10 mg+生理盐水100 ml行术后PCIA。记录术后6、12、24、48 h的VAS疼痛评分，采用流式细胞术于术前1 d、术后24、48 h测定外周血中T淋巴细胞CD3+、CD4+、CD8+百分比并计算CD4+/CD8+比值，采用免疫散射比浊法检测外周血补体C3、C4浓度。记录不良反应的发生情况。
结果 与S组比较，术后6、12、24、48 h NS组VAS疼痛评分明显降低（P<0.05），术后24、48 h N组和NS组T淋巴细胞CD3+百分比和CD4+/CD8+比值均明显升高（P<0.05），术后24 h NS组T淋巴细胞CD4+百分比明显升高（P<0.05）。术后24、48 h N组和S组VAS疼痛评分和C3、C4浓度差异无统计学意义。与N组比较，术后24、48 h NS组T淋巴细胞CD3+、CD4+百分比、CD4+/CD8+比值和C3、C4浓度明显升高（P<0.05），NS组术后恶心、呕吐、头晕、呼吸抑制发生率明显降低（P＜0.05）。
结论 纳布啡复合舒芬太尼用于肝切除术后镇痛可以发挥强效镇痛作用，减轻手术和创伤应激反应导致的免疫抑制，同时减少不良反应。 |
| 英文摘要: |
Objective To investigate the effect of nalbuphine and sufentanil combined with postoperative analgesia on the immune function in patients after hepatectomy.
Methods A total of 120 patients with liver cancer who were planned to undergo open left hemihepatectomy from September 2018 to December 2020, including 65 males and 55 females, aged 18-64 years, BMI 18-25 kg/m2, ASA physical status Ⅰ or Ⅱ, TNM stage Ⅰ or Ⅱ. The patients were randomly divided into three groups: sufentanil group (group S, n = 38), nalbuphine group (group N, n = 42) and nalbuphine combined with sufentanil group (group NS, n = 40). All patients were given routine anesthesia. Group S, sufentanil 2.5 μg/kg + tropisetron 10 mg + normal saline 100 ml underwent postoperative PCIA; Group N, nalbuphine 2 mg/kg + tropisetron 10 mg + normal saline 100 ml underwent postoperative PCIA; Group NS, nalbuphine 1 mg/kg + sufentanil 1.25 μg/kg + tropisetron 10 mg + normal saline 100 ml underwent postoperative PCIA. The VAS pain scores at 6, 12, 24, and 48 hours after surgery were recorded. Flow cytometry was used to determine the percentage of CD3+, CD4+, and CD8+ T lymphocytes in the peripheral blood 1 day before surgery and 24, 48 hours after surgery and the calculate CD4+/CD8+ was calcutated, the immunoscatter turbidimetric method was used to determine the concentration of complement C3 and C4 in peripheral blood. The aderse events were also recorded.
Results Compared with group S, VAS pain score of group NS was significantly decreased at 6, 12, 24 and 48 hours after surgery (P < 0.05), CD3+ T lymphocytes and CD4+/CD8+ of group N and group NS were significantly increased at 24 and 48 hours after surgery (P < 0.05), The CD4+ T lymphocytes in group NS was significantly increased at 24 hours after operation (P < 0.05). There was no significant difference in VAS pain score, the concentration of complement C3, and C4 between group N and group S at 24 and 48 hours after operation. Compared with group N, CD3+, CD4+ T lymphocytes, CD4+/CD8+ and the concentration of complement C3 and C4 in group NS were significantly increased 24 and 48 hours after surgery (P < 0.05), and the incidence of postoperative nausea, vomiting, dizziness and respiratory depression was significantly lower in group NS (P < 0.05).
Conclusion Nalbuphine combined with sufentanil for post-hepatectomy analgesia can exert a strong analgesic effect, reduce the immunosuppression caused by surgery and traumatic stress, and reduce adverse reactions at the same time. |
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