舒芬太尼与丙泊酚静脉复合麻醉对宫颈癌患者免疫功能的影响
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摘要
目的观察舒芬太尼复合丙泊酚对子宫颈癌患者免疫功能的影响。方法选取2015年2月至2017年12月在台州市肿瘤医院择期接受手术治疗的130例宫颈癌患者作为研究对象,并使用随机数字表法将其分为观察组和对照组。在手术麻醉时,观察组选择舒芬太尼复合丙泊酚,对照组为芬太尼复合丙泊酚。对两组患者的手术相关、免疫功能指标进行分析。结果观察组患者睁眼用时及拔管用时均明显小于对照组(t值分别为7.274、5.934,均P<0.05);观察组患者术后2h、6h、1d和2d时的视觉模拟评分(VAS)均明显低于对照组(t值分别为8.273、10.926、9.158、10.400,均P<0.05)。两组患者的肿瘤坏死因子-α(TNF-α)水平均为先降后升,皮质醇、白细胞介素-6(IL-6)为先升后降,术后第7天恢复至术前水平,两组在组间、时间及交互作用均具有统计学差异(TNF-α:F值分别为17.694、23.577、21.586,均P<0.05;皮质醇:F值分别为29.301、39.019、34.762,均P<0.05;IL-6:F值分别为34.589、53.261、46.221,均P<0.05)。术后两组患者CD3~+、CD4~+、CD8~+、CD4~+/CD8~+、NK细胞呈现先降后升的趋势,两组在组间、时间及交互作用均具有统计学差异(CD3~+:F值分别为47.012、54.321、53.011,均P<0.05;CD4~+:F值分别为32.681、66.359、47.096,均P<0.05;CD8~+:F值分别为32.114、53.628、37.116,均P<0.05;CD4~+/CD8~+:F值分别为60.022、66.336、65.851,均P<0.05;NK细胞:F值分别为29.333、49.320、51.128,均P<0.05),观察组在术后第7天基本恢复至术前水平,但是对照组仍低于术前水平(t值分别为3.02、10.56、4.93、2.12、1.36,均P<0.05)。结论舒芬太尼复合丙泊酚用于宫颈癌患者手术,术后的镇痛效果良好,且术后患者免疫功能恢复较快。
Objective To observe the effects of sufentanil combined with propofol on immune function of patients with cervical cancer. Methods We selected 130 patients with cervical cancer receiving surgical treatment in Taizhou Cancer Hospital from February 2015 to December 2017 as research objects, and divided them into observation group and control group according to random number table method. For operation anesthesia, patients in the observation group were given sufentanil combined with propofol, while patients in the control group were given fentanyl combined with propofol. Operation related and immune function indexes in two groups were analyzed. Results In the observation group, time of eye opening and extubation time were significantly shorter than those in the control group(t value was 7.274 and 5.934, respectively, both P<0.05). Visual analogue scale(VAS) scores 2 h, 6 h, 1 d and 2 d after operation in the observation group were significantly lower than those in the control group(t value was 8.273, 10.926, 9.158 and 10.400, respectively, all P<0.05). Levels of tumor necrosis factor-α(TNF-α) in two groups were both descending first and then ascending, and cortisol and interleukin(IL-6) were first ascending and then descending, and they all recovered to preoperative level at 7 d after operation. Recovering time and change range between two groups were statistically significant(TNF-α:F value was 17.694, 23.577 and 21.586, respectively, all P<0.05; cortisol: F value was 29.301, 39.019 and 34.762, respectively, all P<0.05; IL-6: F value was 34.589, 53.261 and 46.221, respectively, all P<0.05). After operation, indexes of CD3~+, CD4~+, CD8~+, CD4~+/CD8~+ and NK in two groups showed a trend of decline first and then rise. The differences between two groups were statistically significant(CD3~+: F value was 47.012, 54.321 and 53.011, respectively, all P<0.05; CD4~+: F value was 32.681, 66.359 and 47.096, respectively, all P<0.05; CD8~+: F value was 32.114, 53.628 and 37.116, respectively, all P<0.05; CD4~+/CD8~+: F value was 60.022, 66.336 and 65.851, respectively, all P<0.05; NK cell:F value was 29.333, 49.320 and 51.128, respectively, all P<0.05). Indexes in the observation group basically recovered to preoperative level at seventh day after operation, but those in the control group were still lower than preoperative level(t value was 3.02, 10.56, 4.93, 2.12 and 1.36, respectively, all P<0.05). Conclusion Sufentanil combined with propofol for cervical cancer surgery has advantages of good postoperative analgesic effect, and faster postoperative immune function recovery.
Objective To observe the effects of sufentanil combined with propofol on immune function of patients with cervical cancer. Methods We selected 130 patients with cervical cancer receiving surgical treatment in Taizhou Cancer Hospital from February 2015 to December 2017 as research objects, and divided them into observation group and control group according to random number table method. For operation anesthesia, patients in the observation group were given sufentanil combined with propofol, while patients in the control group were given fentanyl combined with propofol. Operation related and immune function indexes in two groups were analyzed. Results In the observation group, time of eye opening and extubation time were significantly shorter than those in the control group(t value was 7.274 and 5.934, respectively, both P<0.05). Visual analogue scale(VAS) scores 2 h, 6 h, 1 d and 2 d after operation in the observation group were significantly lower than those in the control group(t value was 8.273, 10.926, 9.158 and 10.400, respectively, all P<0.05). Levels of tumor necrosis factor-α(TNF-α) in two groups were both descending first and then ascending, and cortisol and interleukin(IL-6) were first ascending and then descending, and they all recovered to preoperative level at 7 d after operation. Recovering time and change range between two groups were statistically significant(TNF-α:F value was 17.694, 23.577 and 21.586, respectively, all P<0.05; cortisol: F value was 29.301, 39.019 and 34.762, respectively, all P<0.05; IL-6: F value was 34.589, 53.261 and 46.221, respectively, all P<0.05). After operation, indexes of CD3~+, CD4~+, CD8~+, CD4~+/CD8~+ and NK in two groups showed a trend of decline first and then rise. The differences between two groups were statistically significant(CD3~+: F value was 47.012, 54.321 and 53.011, respectively, all P<0.05; CD4~+: F value was 32.681, 66.359 and 47.096, respectively, all P<0.05; CD8~+: F value was 32.114, 53.628 and 37.116, respectively, all P<0.05; CD4~+/CD8~+: F value was 60.022, 66.336 and 65.851, respectively, all P<0.05; NK cell:F value was 29.333, 49.320 and 51.128, respectively, all P<0.05). Indexes in the observation group basically recovered to preoperative level at seventh day after operation, but those in the control group were still lower than preoperative level(t value was 3.02, 10.56, 4.93, 2.12 and 1.36, respectively, all P<0.05). Conclusion Sufentanil combined with propofol for cervical cancer surgery has advantages of good postoperative analgesic effect, and faster postoperative immune function recovery.
引文
[1]龚智逊,徐英,徐晶晶,等.人文关怀护理对宫颈癌放疗患者的临床应用效果[J].检验医学与临床,2016,13(17):2494-2495.
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[3]Tsai C C,Qiu J T,Tseng C W,et al.Low-dose metronomic chemotherapy with cisplatin enhanced immunity in a murine model of ectopic cervical cancer[J].Clinical & Experimental Pharmacology & Physiology,2016,43(2):251-258.
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[5]Gao H.Effects of total intravenous anesthesia and combined general-epidural anesthesia on erythrocyte immunity in patients undergoing laparoscopic resection of ovarian tumor[J].International Journal of Clinical & Experimental Medicine,2017,10(11):15652-15657.
[6]Xu Q,Shi N J,Zhang H,et al.Effects of combined general-epidural anesthesia and total intravenous anesthesia on cellular immunity and prognosis in patients with non-small cell lung cancer:A comparative study[J].Molecular Medicine Reports,2017,16(4):4445-4454.
[7]Zhu J,Zhang X R,Yang H.Effects of combined epidural and general anesthesia on intraoperative hemodynamic responses, postoperative cellular immunity, and prognosis in patients with gallbladder cancer[J].Medicine,2017,96(10):e6137.
[8]Frampton J E.Sublingual sufentanil:a review in acute postoperative pain[J].Drugs,2016,76(6):719-729.
[9]Huang J,Sheng J,Chen X,et al.Propofol administration during early postnatal life suppresses hippocampal neurogenesis[J].Molecular Neurobiology,2016,53(2):1031-1044.
[10]中华人民共和国国家卫生和计划生育委员会.宫颈癌及癌前病变规范化诊疗指南(试行)[J].慢性病学杂志,2013,5(6):40-49.
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[12]程娟,彭艳.AMI病人急诊PCI术后发生低血压的相关因素分析[J].中西医结合心脑血管病杂志,2016,14(10):1178-1180.
[13]曾琬琴,殷霞,狄文.宫颈癌的免疫治疗进展[J].国际妇产科学杂志,2017,44(6):681-685.
[14]李春霞,杨慧,李春阳,等.不同麻醉方法对宫颈癌手术患者免疫功能的影响[J].实用癌症杂志,2015,30(9):1398-1400.
[15]Borcoman E,Le T C.Pembrolizumab in cervical cancer: latest evidence and clinical usefulness[J].Therapeutic Advances in Medical Oncology,2017,9(6):431.
[16]张玉兰,陈丹,李军,等.腰硬联合麻醉对围手术期剖宫产患者皮质醇及血浆D-D水平的影响[J].现代生物医学进展,2016,16(10):1891-1893.
[17]王少勇,张忠民,黄进堂,等.腹腔镜与开腹手术对胃癌根治术患TNF-α和IL-6水平的影响研究[J].现代生物医学进展,2015,15(3):481-483.
[18]梁富球,林群.不同麻醉方式对非小细胞肺癌患者围术期免疫功能的影响[J].中国老年学杂志,2018,38(16):3897-3899.
[19]武健,王雯珺.不同麻醉方式对小细胞肺癌围手术期免疫功能的影响[J].现代肿瘤医学,2016,24(10):1630-1633.
[20]陈杰,陈梦洁,曾令玉,等.丙泊酚静脉全身麻醉与吸入麻醉2种方式对围手术期患者细胞免疫功能影响的Meta分析[J].新疆医科大学学报,2019,42(01):66-71
[2]Turkistanli E C,Sogukpinar N,Saydam B K,et al.Cervical cancer prevention and early detection--the role of nurses and midwives[J].Asian Pacific Journal of Cancer Prevention Apjcp,2016,4(1):15-21.
[3]Tsai C C,Qiu J T,Tseng C W,et al.Low-dose metronomic chemotherapy with cisplatin enhanced immunity in a murine model of ectopic cervical cancer[J].Clinical & Experimental Pharmacology & Physiology,2016,43(2):251-258.
[4]Saville A M.Cervical cancer prevention in Australia:planning for the future[J].Cancer Cytopathology,2016,124(4):235-240.
[5]Gao H.Effects of total intravenous anesthesia and combined general-epidural anesthesia on erythrocyte immunity in patients undergoing laparoscopic resection of ovarian tumor[J].International Journal of Clinical & Experimental Medicine,2017,10(11):15652-15657.
[6]Xu Q,Shi N J,Zhang H,et al.Effects of combined general-epidural anesthesia and total intravenous anesthesia on cellular immunity and prognosis in patients with non-small cell lung cancer:A comparative study[J].Molecular Medicine Reports,2017,16(4):4445-4454.
[7]Zhu J,Zhang X R,Yang H.Effects of combined epidural and general anesthesia on intraoperative hemodynamic responses, postoperative cellular immunity, and prognosis in patients with gallbladder cancer[J].Medicine,2017,96(10):e6137.
[8]Frampton J E.Sublingual sufentanil:a review in acute postoperative pain[J].Drugs,2016,76(6):719-729.
[9]Huang J,Sheng J,Chen X,et al.Propofol administration during early postnatal life suppresses hippocampal neurogenesis[J].Molecular Neurobiology,2016,53(2):1031-1044.
[10]中华人民共和国国家卫生和计划生育委员会.宫颈癌及癌前病变规范化诊疗指南(试行)[J].慢性病学杂志,2013,5(6):40-49.
[11]刘力生.中国高血压防治指南2010[J].中华心血管病杂志,2011,3(7):42-93.
[12]程娟,彭艳.AMI病人急诊PCI术后发生低血压的相关因素分析[J].中西医结合心脑血管病杂志,2016,14(10):1178-1180.
[13]曾琬琴,殷霞,狄文.宫颈癌的免疫治疗进展[J].国际妇产科学杂志,2017,44(6):681-685.
[14]李春霞,杨慧,李春阳,等.不同麻醉方法对宫颈癌手术患者免疫功能的影响[J].实用癌症杂志,2015,30(9):1398-1400.
[15]Borcoman E,Le T C.Pembrolizumab in cervical cancer: latest evidence and clinical usefulness[J].Therapeutic Advances in Medical Oncology,2017,9(6):431.
[16]张玉兰,陈丹,李军,等.腰硬联合麻醉对围手术期剖宫产患者皮质醇及血浆D-D水平的影响[J].现代生物医学进展,2016,16(10):1891-1893.
[17]王少勇,张忠民,黄进堂,等.腹腔镜与开腹手术对胃癌根治术患TNF-α和IL-6水平的影响研究[J].现代生物医学进展,2015,15(3):481-483.
[18]梁富球,林群.不同麻醉方式对非小细胞肺癌患者围术期免疫功能的影响[J].中国老年学杂志,2018,38(16):3897-3899.
[19]武健,王雯珺.不同麻醉方式对小细胞肺癌围手术期免疫功能的影响[J].现代肿瘤医学,2016,24(10):1630-1633.
[20]陈杰,陈梦洁,曾令玉,等.丙泊酚静脉全身麻醉与吸入麻醉2种方式对围手术期患者细胞免疫功能影响的Meta分析[J].新疆医科大学学报,2019,42(01):66-71