CAJ | 학술논문

目的评价右美托咪定对食管癌根治术后吗啡镇痛时细胞免疫功能的影响.方法全麻下择期食管癌根治术后病人60例,ASA分级Ⅰ或Ⅱ级,性别不限,年龄40 ～ 60岁,体重指数19 ～ 23kg/m2,采用随机数字表法,将病人分为2组(n=30),均采用静脉病人自控镇痛,对照组(C组)镇痛泵药液150 ml含吗啡0.48 mg/kg;右美托咪定组(Dex组)镇痛泵药液150 ml含吗啡0.48 mg/kg及右美托咪定1 μg/kg,维持术后疼痛VAS评分≤3分.于术后24、48、72 h记录吗啡用量;记录恶心、呕吐、瘙痒、心动过缓、低血压、镇静过度、呼吸抑制等不良反应的发生情况.于麻醉诱导前(T0)、气管拔管即刻(T1)、术后24 h、48 h、72 h(T2-4)时,采集外周静脉血样,采用流式细胞仪测定T淋巴细胞亚群(CD3+、CD4+、CD8+)和NK细胞的水平,计算CD4+/CD8+比值.结果与C组比较,Dex组术后24、48、72 h吗啡用量降低,术后恶心、呕吐及瘙痒的发生率降低(P＜0.05).与T0时比较,T1-4时2组CD3+、CD4+、CD4+/CD8+比值和NK细胞水平降低(P＜0.05或0.01);与C组比较,Dex组T1-4时CD3+、CD4+、CD4+/CD8+比值和NK细胞水平升高(P＜0.05).结论右美托咪定可改善食管癌根治术后吗啡镇痛时的细胞免疫功能.
목적 평개우미탁미정대식관암근치술후마배진통시세포면역공능적영향.방법 전마하택기식관암근치술후병인60례,ASA분급Ⅰ혹Ⅱ급,성별불한,년령40 ～ 60세,체중지수19 ～ 23kg/m2,채용수궤수자표법,장병인분위2조(n=30),균채용정맥병인자공진통,대조조(C조)진통빙약액150 ml함마배0.48 mg/kg;우미탁미정조(Dex조)진통빙약액150 ml함마배0.48 mg/kg급우미탁미정1 μg/kg,유지술후동통VAS평분≤3분.우술후24、48、72 h기록마배용량;기록악심、구토、소양、심동과완、저혈압、진정과도、호흡억제등불량반응적발생정황.우마취유도전(T0)、기관발관즉각(T1)、술후24 h、48 h、72 h(T2-4)시,채집외주정맥혈양,채용류식세포의측정T림파세포아군(CD3+、CD4+、CD8+)화NK세포적수평,계산CD4+/CD8+비치.결과 여C조비교,Dex조술후24、48、72 h마배용량강저,술후악심、구토급소양적발생솔강저(P＜0.05).여T0시비교,T1-4시2조CD3+、CD4+、CD4+/CD8+비치화NK세포수평강저(P＜0.05혹0.01);여C조비교,Dex조T1-4시CD3+、CD4+、CD4+/CD8+비치화NK세포수평승고(P＜0.05).결론 우미탁미정가개선식관암근치술후마배진통시적세포면역공능.
Objective To evaluate the effects of dexmedetomidine on the cellular immune function during analgesia with morphine after radical resection for esophageal cancer in the patients.Methods Sixty patients of both sexes,of ASA physical status Ⅰ or Ⅱ,after radical resection for esophageal cancer under general anesthesia,were randomly divided into 2 groups (n =30 each) using a random number table:control group (group C) and dexmedetomidine group (group Dex).Patient-controlled intravenous analgesia (PCIA) was performed immediately after operation in the two groups.In group C,the PCIA solution (150 ml) contained morphine 0.48 mg/kg.In group Dex,the PCIA solution (150 ml) contained morphine 0.48 mg/kg and dexmedetomidine 1 μg/kg.The postoperative visual analogue scale (VAS) scores were maintained ≤ 3.The consumption of morphine was recorded within 24,48 and 72 h after operation.The adverse effects such as nausea,vomiting,pruritus,bradycardia,hypotension,oversedation and respiratory depression were also recorded after operation.Before induction of anesthesia (T0),immediately after extubation (T1),and at 24,48 and 72 h after operation (T2-4),venous blood samples were obtained for determination of the levels of T-lymphocyte subsets (CD3+,CD4+,CD8+) and natural killer (NK) cells by flow cytometry.CD4+/CD8+ ratio was calculated.Results Compared with group C,the consumption of morphine within 24,48 and 72 h after operation and incidence of nausea,vomiting and pruritus after operation were significantly decreased in group Dex.The levels of CD3+,CD4+,CD4+/CD8+ ratio and NK cells were significantly lower at T1-4 than at T0 in the two groups.The levels of CD3+,CD4+,CD4+/CD8+ ratio and NK cells were significantly higher at T1-4 in group Dex than in group C.Conclusion Dexmedetomidine can improve the cellular immune function during analgesia with morphine after radical resection for esophageal cancer in the patients.