羟考酮联合舒芬太尼术后静脉自控镇痛对脊柱外科患者免疫功能的影响
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摘要
目的研究羟考酮联合舒芬太尼术后静脉自控镇痛对脊柱外科患者免疫功能的影响。方法选取骨科及脊柱外科行手术治疗的患者60例,ASAⅠ级、Ⅱ级,随机分为舒芬太尼组(S组)、羟考酮组(Q组)、舒芬太尼和羟考酮联合组(SQ组),每组20例。检测3组患者麻醉前、手术毕、手术后1 d和手术后2 d血清IL-4和IFN-γ的水平。结果手术后2 d,S组与Q组患者IL-4水平显著高于麻醉前水平,差异具有统计学意义(P<0.05),SQ组患者IL-4水平明显低于S组,差异具有统计学意义(P<0.05);术后1 d和术后2 d时,SQ组IFN-γ水平明显低于S组,差异具有统计学意义(P<0.05);术毕Q组IFN/IL-4比例较S组显著下降,差异具有统计学意义(P<0.05);术后1 d Q组和SQ组IFN/IL-4比例均较S组显著下降,差异具有统计学意义(P<0.05)。结论与单用舒芬太尼比较,羟考酮联合舒芬太尼术后静脉自控镇痛可减轻脊柱外科手术患者IFN-γ与IL-4水平的上升,降低炎症反应。
Objective To investigate the effect of patient controlled intravenous analgesia( PCIA) with oxycodone and sufentanyl on the immune function in patients undergoing spinal column surgery. Methods 60 patients undergoing spinal column surgery at ASA Ⅰ,Ⅱ were randomly divided into three groups,including administered sufentanyl group( group S),administered oxycodone group( group Q),and administered oxycodone and sufentanyl group( roup SQ),with every 20 cases in each group.The serum levels of IL- 4 and IFN- γ were measured before anesthesia baselines,after operation,1 day after operation and 2days after operation. Results At 2 days after operation,IL- 4 levels in group S and group Q were significantly higher than that before anesthesia baselines,with the difference statistically significant( P < 0. 05). And IL- 4 level in group SQ was significantly lower than that in group S( P < 0. 05). IFN- γ level in group SQ was significantly lower than that in group S at 1 day and2 days after operation,with the difference statistically significant( P < 0. 05). The level of IFN / IL- 4 in group Q significantly decreased than that in group S,with the difference statistically significant( P < 0. 05). The level of IFN / IL- 4 in group SQ and group Q was significantly lower than that in group S at 1 day after operation,with the difference statistically significant( P <0. 05). Conclusion Compared with the single applicaation of sufentanyl,patient controlled intravenous analgesia( PCIA) with oxycodone and sufentanyl can lower the IFN- γ and IL- 4 levels in patients undergoing spinal column surgery.
Objective To investigate the effect of patient controlled intravenous analgesia( PCIA) with oxycodone and sufentanyl on the immune function in patients undergoing spinal column surgery. Methods 60 patients undergoing spinal column surgery at ASA Ⅰ,Ⅱ were randomly divided into three groups,including administered sufentanyl group( group S),administered oxycodone group( group Q),and administered oxycodone and sufentanyl group( roup SQ),with every 20 cases in each group.The serum levels of IL- 4 and IFN- γ were measured before anesthesia baselines,after operation,1 day after operation and 2days after operation. Results At 2 days after operation,IL- 4 levels in group S and group Q were significantly higher than that before anesthesia baselines,with the difference statistically significant( P < 0. 05). And IL- 4 level in group SQ was significantly lower than that in group S( P < 0. 05). IFN- γ level in group SQ was significantly lower than that in group S at 1 day and2 days after operation,with the difference statistically significant( P < 0. 05). The level of IFN / IL- 4 in group Q significantly decreased than that in group S,with the difference statistically significant( P < 0. 05). The level of IFN / IL- 4 in group SQ and group Q was significantly lower than that in group S at 1 day after operation,with the difference statistically significant( P <0. 05). Conclusion Compared with the single applicaation of sufentanyl,patient controlled intravenous analgesia( PCIA) with oxycodone and sufentanyl can lower the IFN- γ and IL- 4 levels in patients undergoing spinal column surgery.
引文
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[8]王玉兰,嵇富海.BIS指导下不同麻醉方法对胆囊切除术患者围术期细胞免疫功能影响的比较[J].中华麻醉学杂志,2010,30(8):1021-1022.
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[10]Xiong X,Gu L,Li L,et al.Gycyrrhizin protects against focal ischemia and attenuates peripheral immunosuppression in rats[J].Stroke,2011,43(30):e67-e68.
[11]Chamorro A1,Urra X,Planas AM.Infection after acute ischemic stroke:a manifestation of brain-induced immunodepression[J].Stroke,2007,38(3):1097-1103.
[12]李文波,徐树生,赵玉国,等.舒芬太尼对直肠癌根治术患者Th1/Th2平衡的影响[J].中国现代医学杂志,2012,22(2):51-54.
[13]Pachot A,Monneret G,Voirin N,et al.Longitudinal study of cytokine and immune transcription factor mRNA expression in septic shock[J].Clin Immunol,2005,114(1):61-69.
[14]Venet F,Lepape A,Debard AL,et al.The Th2 response as monitored by CRTH2 or CCR3 expression is severely decreased during septic shock[J].Clin Immunol,2004,113(3):278-284.
[15]Boo YJ,Kim WB,Kim J,et al.Systemic immune response afteropen versus laparoscopic cholecystectomy in acute cholecystitis:aprospective randomized study[J].Scand J Clin Lab Invest,2007,67(2):207-214.
[2]Lenz H,Sandvik L,Qvigstad E,et al.A comparison of intravenous oxycodone and intravenous morphine in patient-controlled postoperative analgesia after laparoscopic hysterectomy[J].Anesth Analg,2009,109(4):1279-1283.
[3]张柏银,唐吉伟,李峰,等.羟考酮复合舒芬太尼经静脉自控镇痛在脊柱外科术后的镇痛作用[J].中国现代医学杂志,2015,25(11):59-62.
[4]维拉,姜莉莉,宣斐.曲马多和吗啡术后镇痛对胃癌手术患者免疫功能的影响[J].临床麻醉学杂志,2011,27(10):979-981.
[5]Goumon Y,Stefano GB,Aunis D,et al.Implication of endogenous morphine in the communication between neuroendocrine and immune systems[J].Ann N Y Acad Sci,2002,971:542-543.
[6]Wada H,Seki S,Takahashi T.Combined spinal and general anesthesia attenuates liver metastasis by preserving T H1/TH 2 cytokine balance[J].Anesthesiology,2007,106:499-506.
[7]Bonz AW1,Lengenfelder B,Jacobs M,et al.Cytokine response after percutaneous coronary intervention in stable angina:effect of selective glycoprotein IIb/IIIa receptor antagonism[J].Am Heart J,2003,145(4):693-699.
[8]王玉兰,嵇富海.BIS指导下不同麻醉方法对胆囊切除术患者围术期细胞免疫功能影响的比较[J].中华麻醉学杂志,2010,30(8):1021-1022.
[9]严春燕.不同切肝方式、不同麻醉、镇痛方法对术后代谢及免疫功能的影响[D].杭州:浙江大学,2011.
[10]Xiong X,Gu L,Li L,et al.Gycyrrhizin protects against focal ischemia and attenuates peripheral immunosuppression in rats[J].Stroke,2011,43(30):e67-e68.
[11]Chamorro A1,Urra X,Planas AM.Infection after acute ischemic stroke:a manifestation of brain-induced immunodepression[J].Stroke,2007,38(3):1097-1103.
[12]李文波,徐树生,赵玉国,等.舒芬太尼对直肠癌根治术患者Th1/Th2平衡的影响[J].中国现代医学杂志,2012,22(2):51-54.
[13]Pachot A,Monneret G,Voirin N,et al.Longitudinal study of cytokine and immune transcription factor mRNA expression in septic shock[J].Clin Immunol,2005,114(1):61-69.
[14]Venet F,Lepape A,Debard AL,et al.The Th2 response as monitored by CRTH2 or CCR3 expression is severely decreased during septic shock[J].Clin Immunol,2004,113(3):278-284.
[15]Boo YJ,Kim WB,Kim J,et al.Systemic immune response afteropen versus laparoscopic cholecystectomy in acute cholecystitis:aprospective randomized study[J].Scand J Clin Lab Invest,2007,67(2):207-214.