酮咯酸氨丁三醇预防性镇痛对肺癌手术患者免疫功能的影响

doi:10.11904/j.issn.1002-3070.2020.02.016

摘要/Abstract

摘要： 目的探讨酮咯酸氨丁三醇预防性镇痛对肺癌手术患者免疫功能的影响。方法选取2017年9月—2019年9月大连市第五人民医院肺癌手术患者172例,依据随机数字表分为预防组和全麻组,每组86例,全麻组给予全麻干预,预防组在此基础上给予酮咯酸氨丁三醇预防性镇痛干预,比较两组平均动脉压(MAP)、心率(HR)、视觉模拟评分法(VAS)、免疫球蛋白(IgA、IgG、IgM)、T淋巴细胞亚群(CD3⁺、CD4⁺、CD4⁺/CD8⁺)以及不良反应。结果预防组麻醉15 min后(T₁)、组织切开时(T₂)、肿瘤切除时(T₃)的MAP、HR明显低于全麻组,差异有统计学意义(P＜0.001);预防组术后IgA、IgG、IgM、CD3⁺、CD4⁺、CD4⁺/CD8⁺明显高于全麻组,差异有统计学意义(P＜0.001);预防组术后4 h、24 h、48 h、72 h的VAS评分明显低于全麻组,差异有统计学意义(P＜0.001);预防组和全麻组不良反应发生率差异无统计学意义(P＜0.05)。结论酮咯酸氨丁三醇预防性镇痛可有效改善肺癌手术患者血流动力学波动及镇痛效果,有利于改善患者免疫功能,且安全性好,值得临床推广。

关键词: 酮咯酸氨丁三醇, 预防性镇痛, 肺癌手术, 免疫功能

Abstract: Objective The Objective of this study was to investigate the effect of ketorolac tromethamine on preventive analgesia in the immune function of patients with lung cancer surgery.Methods A total of 172 patients with lung cancer surgery in our hospital from September 2017 to September 2019 were selected and divided into the prevention group and general anesthesia group according to the random number table.Each group had 86 cases.The general anesthesia group was given general anesthesia intervention.The prevention group was given ketorolac tromethamine as the preventive analgesia.On the basis,the mean arterial pressure(MAP),heart rate(HR),visual analogue scale(VAS),immune globulin(IgA,IgG,and IgM)and T lymphocyte subsets(CD3⁺,CD4⁺,and CD4⁺/CD8⁺)and adverse reaction were compared between the prevention and general anesthesia groups.Results The MAP and HR in the prevention group at 15 min after anesthesia(T₁),tissue incision(T₂),tumor resection(T₃)were significantly lower than those in the general anesthesia group,the difference was statistically significant(P＜ 0.001).The levels of IgA,IgG,IgM,CD3⁺,CD4⁺,and CD4⁺/CD8⁺ in the prevention group after operation were significantly higher than those in the general anesthesia group,the difference was statistically significant(P＜ 0.001).The VAS scores in the prevention group at 4 h,24 h,48 h and 72 h were significantly lower than that in the general anesthesia group,the difference was statistically significant(P＜ 0.001).There was no significant difference in the incidence of adverse reactions between the prevention and general anesthesia groups(P＞0.05).Conclusion Preventive analgesia with ketorolac tromethamine can effectively improve the hemodynamic fluctuations and analgesic effect on patients with lung cancer surgery,and it is beneficial to improve the immune function of patients.It has good safety and worth for further clinical application.

Key words: Ketorolac tromethamine, Preventive analgesia, Lung cancer surgery, Immune function

中图分类号:

朱玉成, 孙昕, 孟丹. 酮咯酸氨丁三醇预防性镇痛对肺癌手术患者免疫功能的影响[J]. 实用肿瘤学杂志, 2020, 34(2): 176-180.

ZHU Yucheng, SUN Xin, MENG Dan. The effect of ketorolac tromethamine on preventive analgesia in the immune function of patients with lung cancer surgery[J]. Journal of Practical Oncology, 2020, 34(2): 176-180.

0
/ / 推荐

导出引用管理器 EndNote|Reference Manager|ProCite|BibTeX|RefWorks

链接本文: http://journal09.magtechjournal.com/Jwk3_syzlxzz/CN/10.11904/j.issn.1002-3070.2020.02.016

http://journal09.magtechjournal.com/Jwk3_syzlxzz/CN/Y2020/V34/I2/176

参考文献

1 刘先岭,智明明,王静静,等.胸椎旁神经阻滞复合全身麻醉对胸腔镜肺癌根治术患者镇痛及免疫细胞功能的影响[J].中国现代医学杂志,2017,27(22):47-51.
2 Fujiwara H,Sato T,Okada N,et al.Thoracoscopic esophagectomy with three-field lymphadenectomy for thoracic esophageal cancer in a patient with a double aortic arch:a report of a case[J].Surg Case Rep,2019,5(1):80.
3 杨淼,邓云坤,章放香,等.酮咯酸氨丁三醇对老年患者术后早期认知功能的影响[J].中国老年学杂志,2018,38(2):425-427.
4 Oswald N,Halle-Smith J,Kerr A,et al.Perioperative immune function and pain control may underlie early hospital readmission and 90 day mortality following lung cancer resection:a prospective cohort study of 932 patients[J].Eur J Surg Oncol,2019,45(5):863-869.
5 胡丰登,张婷,陈银巧,等.盐酸羟考酮注射液预处理在肺癌根治术中的应用效果及对机体免疫功能的影响[J].中国临床保健杂志,2018,21(1):66-69.
6 Lee EK,Ahn HJ,Zo JI,et al.Paravertebral block does not reduce cancer recurrence,but is related to higher overall survival in lung cancer surgery:a retrospective cohort study[J].Anesth Analg,2017,125(4):1322-1328.
7 钟雪莱,杨海粒,王国年.不同麻醉方式对老年肺癌患者术后认知功能的影响[J].实用肿瘤学杂志,2018,32(5):432-436.
8 Chen J,Luo F,Lei M,et al.Study on cellular immune function of patients treated with radical resection of pulmonary carcinoma with two different methods of anesthesia and analgesia[J].J BUON,2017,22(6):1416-1421.
9 常永丽,许银红,温雪敏,等.地佐辛复合酮咯酸氨丁三醇超前镇痛对大鼠术后痛阈和炎性反应的影响[J].中国临床药理学与治疗学,2017,22(3):267-271.
10 高玉峰,汤新,郭旭东,等.地佐辛联合酮咯酸氨丁三醇预防性镇痛对腹腔镜胆囊切除术患者辅助麻醉和术后复苏质量的影响[J].广东医学,2018,39(1):43-46.
11 Jadhav PA,Yadav AV.Design.development and characterization of ketorolac tromethamine polymeric nanosuspension[J].Ther Deliv,2019,10(9):585-597.
12 王爱桃,姚尚龙,杜晓冰,等.酮咯酸氨丁三醇预防性镇痛对乳腺癌改良根治术患者镇痛效果及免疫功能的影响[J].临床麻醉学杂志,2016,32(11):1084-1086.
13 Wagner-Kovacec J,Povalej-Brzan P,Mekis D.Efficacy of continuous in-wound infusion of levobupivacaine and ketorolac for post-caesarean section analgesia:a prospective,randomised,double-blind,placebo-controlled trial[J].BMC Anesthesiol,2018,18(1):165.
14 崔婷婷,周国庆,陈东升,等.超声引导下胸椎旁神经阻滞复合全身麻醉对肺癌根治术患者的影响[J].中国肿瘤临床与康复,2018,25(12):1481-1484.
15 Babar L,Kosovec JE,Jahangiri V,et al.Prognostic immune markers for recurrence and survival in locally advanced esophageal adenocarcinoma[J].Oncotarget,2019,10(44):4546-4555.

[1]	马超(综述), 王国年(审校). 麻醉药物对围术期癌症患者免疫功能的影响[J]. 实用肿瘤学杂志, 2018, 32(3): 285-288.
[2]	李禾南(综述), 张瑞芹(审校). 肿瘤患者围术期免疫功能的影响因素[J]. 实用肿瘤学杂志, 2017, 31(2): 183-187.
[3]	柴静波, 李萍, 裴志萍. 番茄红素对荷卵巢癌大鼠免疫功能的影响及其机制研究[J]. 实用肿瘤学杂志, 2017, 31(1): 13-17.
[4]	孙大为，雷明辉. 高压氧联合术后辅助化疗对口腔癌患者免疫及肿瘤复发的影响[J]. 实用肿瘤学杂志, 2016, 30(6): 533-537.
[5]	王坤, 王玉, 徐杨, 姚丹丹, 王国年. 电针刺对Lewis肺癌化疗小鼠脾脏T淋巴细胞免疫功能的影响[J]. 实用肿瘤学杂志, 2009, 23(6): 548-550.
[6]	林昭明, 李伟. 不同镇痛模式对行宫颈癌根治术病人细胞免疫功能的影响[J]. 实用肿瘤学杂志, 2009, 23(5): 473-475.
[7]	隋红;白玉贤;孙秀威;刘钢新;王凯冰. 热化疗治疗晚期腹盆腔恶性肿瘤近期疗效分析[J]. 实用肿瘤学杂志, 2005, 19(06): 410-413.
[8]	施红;顾惜春;朱玲;邢宝利;许晓东. 胸腺肽对恶性血液病化疗病人T细胞亚群的影响[J]. 实用肿瘤学杂志, 2000, 14(01): 42-43.