【作者】 陈荣；

【导师】 邱晓东；

【作者基本信息】 东南大学 ， 麻醉学（专业学位）， 2017， 硕士

【摘要】 目的观察吗啡联合右美托咪定用于胃癌患者术后镇痛的镇痛效果、不良反应及对免疫功能的影响。方法选择2015年8月至2016年7月本院择期作胃癌根治术的患者112例,ASA分级Ⅰ-Ⅱ级,随机分为C组(对照组)和D组(右美托咪定组),每组各56例,两组均在拔管后予以PCIA。C组给予吗啡100mg+盐酸托烷司琼10mg,D组采用吗啡82mg+右美托咪定200ug+盐酸托烷司琼10mg。将药物加入0.9%氯化钠注射液中至总量为200ml。镇痛泵设置为背景剂量2ml/h,按压1次2ml,按压后锁定时间15分钟。维持VSA≤4分。记录两组术后24h、48h吗啡用量、PCA总次数和有效按压次数;记录使用镇痛泵期间不良反应(恶心呕吐、皮肤搔痒、心动过缓、低血压、镇静过度和呼吸抑制);记录两组于术前、拔管后、24h、72h、120h五个时点T淋巴细胞亚群(CD3+、CD4+、CD8+)及NK细胞水平。结果与C组比较,D组术后24h和48h内吗啡用量、PCA总按压次数和有效按压次数显著减少(P<0.01);与C组比较,D组恶心、呕吐和瘙痒发生率降低(P<0.05);两组CD3+、CD4+、CD4+/CD8+和NK细胞随时间变化,趋势不一致,术后24h最低然后逐渐恢复。与C组比较,D组在术后24h、72h二时段内CD3+、CD4+、CD4+/CD8+和NK细胞水平显著高于C组(P<0.01),说明在此期间D组免疫抑制作用明显轻于C组。结论吗啡联合右美托咪定用于胃癌患者术后镇痛,可明显减少吗啡的总使用量;降低术后镇痛不良反应率;减轻肿瘤患者恢复期免疫抑制状态。更多还原

【Abstract】 ObjectiveTo observe the effect of morphine combined with Dexmedetomidine in PCIA of analgesia and adverse reactions and immunologic function in gastric cancer patients after abdominal operation.MethodsFrom August 2015 to July 2016 in our department,112 cases of patients with ASA Physical status Ⅰ-Ⅱ were randomly divided into group C(control group)and group D(Dexmedetomidine group).Each group has 56 cases.The PCIA pump was connected immediately after the end of surgery.Group C administrated with morphine(100mg)+Tropisetron HCl(10mg),and group D administrated with morphine(82mg)+Dexmedetomidine(200ug)+Tropisetron HCl(10mg).All the anesthetic agents werw diluted into 200 ml of 0.09 sodium chloride PCIA was fixed as background does of 2 ml/h,does of 2 ml/once and lock time of 15 min.The VSA score was maintained below 4.The Ramsay score was maintained between 2-3.The total mount of morphine consumed the number of attempts and successfully delivered doses within 24 48h after operation were recorded.Postoperative complications including nausea,vomiting,bradycardia,hypotension,over sedation and respiratory depression were recorded.The expressions of T-lymphocyte subsets(CD3+、CD4+、CD8+)and natural killer cells were measured by flowcytometry at five time points:before anesthesia,during extubation,24h,72h,120h after operation.ResultsThe total mount of morphine consumed the number of attempts and successfully delivered doses within 24 48h after operation were significantly smaller and the incidence of nausea and vomiting and pruritus was significantly lower in group D than in group C.No bradycardia,hypotension,over sedation respiratory depression was observed in each group.the trend was not consistent with time shift about the CD3+,CD4+,CD4+/CD8+expression with T cell and NK cell in the two groups and the period at 24 hour was th e lowest after operation and recovered gradually then.Compared with C group,CD3+,CD4+,CD4+/CD8+ T cell and NK cell levels were significantly higher in group CD3 t han in group C(P<0.01)at the 24 hour and 72 hour after operation which indicated th at the immunosuppressive effect of D group was significantly less than that of group B.ConclusionPCIA morphine combined with Dexmedetomidine can achieve the favorable VS A and sedation effect,and reduce the amount of morphine and postoperative untoward effect.It contributes more to recover cell mediate immunity of the patients suffering excision of gastric cancer.更多还原