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| 羟考酮自控静脉镇痛对胃癌根治术患者免疫功能及胃肠功能恢复的影响 |
| Effects of oxycodone applied for patient-controlled intravenous analgesia on immunity and gastrointestinal function in patients undergoing radical gastrectomy |
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| DOI：10.12089/jca.2026.01.005 |
| 中文关键词: 羟考酮 舒芬太尼 患者自控静脉镇痛 免疫功能 胃肠功能 |
| 英文关键词: Oxycodone Sufentanil Patient-controlled intravenous analgesia Immune function Gastrointestinal function |
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| 中文摘要: |
目的：评估羟考酮与舒芬太尼患者自控静脉镇痛（PCIA）对胃癌根治术患者免疫功能及胃肠功能恢复的影响。
方法：选择择期全麻下行胃癌根治术患者，年龄18～64岁，BMI 18～30 kg/m2，ASA Ⅱ或Ⅲ级。将患者随机分为两组：羟考酮组（O组）和舒芬太尼组（S组）。所有患者术毕行PCIA，O组镇痛方案为羟考酮1 mg/kg、托烷司琼8 mg加生理盐水至100 ml；S组镇痛方案为舒芬太尼1 μg/kg、托烷司琼8 mg加生理盐水至100 ml。镇痛泵参数设置：首次剂量2 ml，背景剂量1.5 ml/h，单次按压剂量2 ml，锁定时间10 min。主要指标为术后24 CD4+T细胞计数。次要指标包括术前、术后72 h CD4+T细胞计数，术前、术后24、72 h CD8+、CD4+/CD8+、NK细胞计数，术后首次肛门排气时间、术后首次排便时间、胃管留置时间、鼻空肠营养管留置时间、术后住院时间，术后2、24、48 h静息及活动时的疼痛数字评分（NRS）与Ramsay镇静评分、术后不良反应的发生情况和补救镇痛情况。
结果：共纳入患者180例，每组90例。与S组比较，O组术后24、72 h CD4+T细胞计数、CD4+/CD8+T细胞计数明显升高，CD8+T细胞计数明显降低，术后72 h NK细胞计数明显升高，术后首次肛门排气时间、术后首次排便时间、术后住院时间均明显缩短，术后2 h静息和活动时NRS评分均明显降低（P＜0.05）。两组术后鼻胃管留置时间、鼻空肠营养管留置时间、术后不同时点Ramsay镇静评分、补救镇痛率差异无统计学意义。
结论： 与舒芬太尼比较，羟考酮用于胃癌根治术患者术后PCIA能够减轻免疫抑制，加快胃肠功能恢复，且镇痛效果明确，有助于患者术后恢复。 |
| 英文摘要: |
Objective: To evaluate the effects of oxycodone versus sufentanil patient-controlled intravenous analgesia (PCIA) on immunity and gastrointestinal function recovery in patients undergoing radical gastrectomy.
Methods: Patients aged 18-64 years, BMI 18-30 kg/m2, ASA physical status Ⅱ or Ⅲ, scheduled for elective radical gastrectomy under general anesthesia were included. Patients were assigned to two groups: oxycodone group (group O) and sufentanil group (group S). All patients received PCIA after surgery. The analgesic regimen for group O was formulated as oxycodone 1 mg/kg, tropisetron 8 mg, added with normal saline to 100 ml. The analgesic regimen for group S was sufentanil 1 μg/kg, tropisetron 8 mg, added with normal saline to 100 ml. The pump setting was as follows: a loading dose of 2 ml, a background dose of 1.5 ml/h, a single patient-controlled additional dose of 2 ml, and a locking time of 10 minutes. Primary outcome included CD4+ T cells at 24 hours postoperatively. Secondary outcomes included preoperative and 72 hours postoperative CD4+ T cell counts, preoperative and 24 and 72 hours postoperative CD8+, CD4+/CD8+, and NK cell counts time to first flatus/defecation, duration of nasogastric/nasointestinal tube placement, hospital stay, NRS pain scores at rest/activity at 2, 24, 48 hours postoperativly, Ramsay sedation scores, adverse events, and rescue analgesia use.
Results: A total of 180 patients were included, with 90 patients in each group. Compared with group S, the CD4+ T cells and CD4+/CD8+ at 24 and 72 hours postoperatively were increased, the CD8+ T cells at 24 and 72 hours postoperatively were decreased (P < 0.05). Compared with group S, the time to first flatus and first defecation after surgery were decreased, the length of hospital stay after surgery was decreased, and NRS pain scores at rest and during movement at 2 hours postoperatively were decreased (P < 0.05). There were no significant differences in time of indwelling nasogastric tube, time of indwelling nasojejunal tube, RSS scores at different time points, rescue analgesia rate between the two groups.
Conclusion: Oxycodone PCIA demonstrated superior immune-preserving effects, faster gastrointestinal recovery, and comparable analgesia to sufentanil in post-gastrectomy patients, which was beneficial to the postoperative recovery of patients. |
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