Objective To investigate the effect of postoperative patient controlled intravenous analgesia (PCIA) with dezocine combined sufentanil on immune function in tumor patients.Methods Sixty general anesthesia patients(ASA Ⅰ or Ⅱ grade,38 to 79 years) undergoing selective radical operation for gastroenteric tumor were randomly divided into 2 groups:the postoperative analgesics were dezocine 0.25 mg/kg ± sufentanil 1.5 μg/kg ±tropisetron 6 mg(group DS),sufentanil 2.5 μg/kg ± tropisetron 6 mg(group S).All patients were given the same anaesthetic techniques.The analgesic effects of two groups were estimated with the visual analog scale (VAS) at different time points after operation.Blood samples were collected before anesthesia(T0),operation end(T1)and 12 h(T2),24 h(T3),48 h(T4) after surgery for determination of T-lymphocyte subsets (CD3 +,CD4 +,CD8 +) and natural killer cells (NK) were measured by flow cytometry.Results There were no statistical difference in VAS at any time point between the two groups (P ＞ 0.05).Compared with baseline value,the level of CD3 +,CD4 + were decreased significantly at T1-T4 in two groups [group DS:(47.2 ± 6.3) ％,(46.5 ± 6.8) ％,(46.8 ± 7.4) ％,(47.6±7.8)％ vs(54.2±8.7)％,(26.7±3.2)％,(25.8±3.0)％,(25.1±3.3)％,(28.1 ±3.6)％ vs (32.6±2.6)％;groupS:(46.8±7.2)％,(45.7±6.4)％,(42.6±5.9)％,(46.1 ±6.9)％ vs(54.8±8.5)％,(26.3±3.1)％,(24.4±2.9)％,(21.2±2.8)％,(27.4±3.2)％ vs(33.2±2.1)％,all P＜0.05].The amounts of natural killer cells were increased significantly at T1-T3 [group DS:(9.3 ± 0.8) ％,(8.9±1.3)％,(10.2±1.4)％ vs(13.8±1.2)％;group S:(9.5±0.7)％,(9.0±1.1)％,(8.6±1.2)％vs(13.6 ± 1.3)％,all P ＜0.05].There were no significantly difference with regard to CD8+ lymphocyte at any time point between the two groups (P ＞ 0.05).Compared with group S,the level of CD3 +,CD4 +,natural killer cell in thee group DS were significantly increased at T3 (P ＜ 0.05).In the group DS,the level of natural killer cell was recovered to baseline value at T4 (P ＞ 0.05).Conclusion PCIA with dezocine combined sufentanil or with sufentanil alone may provide satisfactory postoperative analgesia for patients,but the combination is more beueficial for the cell-immunity recovery after gastroenteric tumor surgery.%目的 观察地佐辛复合舒芬太尼用于术后静脉自控镇痛对肿瘤患者免疫功能的影响.方法 择期全身麻醉下行胃肠道恶性肿瘤根治术患者60例,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,年龄38 ～ 79岁.采用随机数字表法,分为地佐辛复合舒芬太尼组和舒芬太尼组,每组30例.2组患者术毕清醒后,均接静脉自控镇痛泵.地佐辛复合舒芬太尼组泵中药物配制为地佐辛0.25 mg/kg±舒芬太尼1.5 μg/kg±托烷司琼6 mg;舒芬太尼组为舒芬太尼2.5μg/kg±托烷司琼6 mg.2组患者均采用相同的麻醉方法.2组患者术后各时点采用视觉模拟评分(VAS评分)行镇痛效果评价；分别于麻醉前(基础值,T0)、术毕(T1)及术后12 h(T2)、24 h(T3)、48 h(T4)抽取静脉血,用流式细胞仪测定其T淋巴细胞亚群(CD3+、CD4+、CD8+)及自然杀伤细胞水平.结果 2组患者术后各时点VAS评分比较差异均无统计学意义(均P＞0.05)；与T0时比较,T1～T4时地佐辛复合舒芬太尼组和舒芬太尼组患者CD3+、CD4+水平均明显降低[地佐辛复合舒芬太尼组:(47.2±6.3)％、(46.5±6.8)％、(46.8±7.4)％、(47.6±7.8)％比(54.2±8.7)％,(26.7±3.2)％、(25.8±3.0)％、(25.1±3.3)％、(28.1±3.6)％比(32.6±2.6)％；舒芬太尼组:(46.8±7.2)％、(45.7±6.4)％、(42.6±5.9)％、(46.1±6.9)％比(54.8±8.5)％,(26.3±3.1)％、(24.4±2.9)％、(21.2±2.8)％、(27.4±3.2)％比(33.2±2.1)％,均P＜0.05],T1～T3时2组患者自然杀伤细胞水平低于T0[地佐辛复合舒芬太尼组:(9.3±0.8)％、(8.9±1.3)％、(10.2±1.4)％比(13.8±1.2)％；舒芬太尼组:(9.5±0.7)％、(9.0±1.1)％、(8.6±1.2)％比(13.6±1.3)％,均P＜0.05].2组各时点CD8+水平比较差异无统计学意义(P＞0.05).地佐辛复合舒芬太尼组T3时CD3+、CD4+、自然杀伤细胞水平明显高于舒芬太尼组(P＜0.05)；地佐辛复合舒芬太尼组T4时自然杀伤细胞水平已恢复到T0水平,明显高于舒芬太尼组(P＜0.05).结论 地佐辛复合舒芬太尼与单纯舒芬太尼术后静脉镇痛都能取得满意的镇痛效果,但前者更有利于肿瘤患者术后细胞免疫功能的恢复.
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