CAJ | 학술논문

背景：多模式镇痛模式应用于肾移植受者可有效减轻疼痛，并有利于移植肾功能恢复。目的：观察地佐辛多模式镇痛对肾移植后患者免疫功能的影响，并探讨合适的移植后镇痛药物及方式。方法：40例肾移植患者随机分为两组，均行硬膜外阻滞复合全身麻醉。对照组间断肌注镇痛药物，地佐辛多模式镇痛组给予地佐辛超前镇痛+术后硬膜外患者自控镇痛。记录麻醉前，移植后12，24，48 h的心率、动脉平均血压、血氧饱和度；抽取静脉血检测T淋巴细胞亚群含量和白细胞介素2、白细胞介素6和白细胞介素10水平。结果与结论：与麻醉前比较，对照组移植后CD4+、CD8+、CD4+/CD8+、白细胞介素2和白细胞介素6水平均明显下降(P<0.05)，白细胞介素10水平明显升高(P<0.05)。地佐辛多模式镇痛组CD4+、白细胞介素2、白细胞介素6水平在移植后12 h低于麻醉前(P<0.05)，移植后24 h则恢复至麻醉前水平。CD8+、CD4+/CD8+与移植前比较变化不明显。白细胞介素10水平在移植后48 h明显高于移植前，但低于对照组(P<0.05)。结果可见地佐辛多模式镇痛对肾移植后免疫功能有一定的保护作用，对患者移植肾肾功能短期转归和移植物的长期存活起积极作用。
배경：다모식진통모식응용우신이식수자가유효감경동통，병유리우이식신공능회복。목적：관찰지좌신다모식진통대신이식후환자면역공능적영향，병탐토합괄적이식후진통약물급방식。방법：40례신이식환자수궤분위량조，균행경막외조체복합전신마취。대조조간단기주진통약물，지좌신다모식진통조급여지좌신초전진통+술후경막외환자자공진통。기록마취전，이식후12，24，48 h적심솔、동맥평균혈압、혈양포화도；추취정맥혈검측T림파세포아군함량화백세포개소2、백세포개소6화백세포개소10수평。결과여결론：여마취전비교，대조조이식후CD4+、CD8+、CD4+/CD8+、백세포개소2화백세포개소6수평균명현하강(P<0.05)，백세포개소10수평명현승고(P<0.05)。지좌신다모식진통조CD4+、백세포개소2、백세포개소6수평재이식후12 h저우마취전(P<0.05)，이식후24 h칙회복지마취전수평。CD8+、CD4+/CD8+여이식전비교변화불명현。백세포개소10수평재이식후48 h명현고우이식전，단저우대조조(P<0.05)。결과가견지좌신다모식진통대신이식후면역공능유일정적보호작용，대환자이식신신공능단기전귀화이식물적장기존활기적겁작용。
BACKGROUND:Multimodal analgesia provides sufficient analgesia in renal recipients and appears to be associated with the recovery of renal function after transplantation. OBJECTIVE:To investigate the effect of multimodal analgesia with dezocine on postoperative immunity after renal transplantation, and discuss the appropriate analgesic drugs and methods for patients with renal transplantation. METHODS:Forty patients undergoing renal transplantation were randomly divided into two groups. They al received general anesthesia combined with epidural blockage. Control group received intramuscular injection of analgesic drugs when needed, while dezocine group received multimodal analgesia:preemptive anaIgesia with dezocine+patient-control ed epidural analgesia. The heart rate, mean arterial pressure, and saturation of blood oxygen were detected before anesthesia, 12, 24, 48 hours after transplantation. T lymphocyte subsets, interleukin-2, interleukin-6 and interleukin-10 levels in venous blood were measured before anesthesia, 12, 24, 48 hours after transplantation. RESULTS AND CONCLUSION:Compared with before anesthesia, the CD4+, CD8+cellsubset counts, CD4+/CD8+ratio, the levels of interleukin-2 and interleukin-6 were decreased significantly (P<0.05), and the levels of interleukin were significantly increased after transplantation in the control group (P<0.05). The postoperative CD4+cellsubset counts, the levels of interleukin-2 and interleukin-6 were significantly lower at 12 hours after transplantation than that before anesthesia (P<0.05), then recovered to normal levels at 24 hours in dezocine group. The postoperative CD8+cellsubset counts, CD8+and CD4+/CD8+ratio were not changed before and after transplantation in the dezocine group. The levels of interleukin-10 in the dezocine group were significantly increased at 48 hours after transplantation compared with before anesthesia (P<0.05), which was stil lower than that in control group (P<0.05). Multimodal analgesia with dezocine can effectively protect the immune system, promote short-term turnover of renal function, and prolong graft survival for patients with renal transplantation.