纳布啡超前镇痛联合罗哌卡因局部浸润对小儿术后切口疼痛、应激反应及免疫功能的影响

摘要

目的:研究纳布啡超前镇痛联合罗哌卡因局部浸润对小儿术后切口疼痛、应激反应及免疫功能的影响.方法:选择在本院接受择期开腹手术的小儿患者,随机分为对照组、纳布啡组(N组)、罗哌卡因组(R组)、纳布啡+罗哌卡因组(N+R组).手术前及手术后24小时,检测血清中疼痛及应激相关介质的含量及外周血中免疫细胞的含量.结果:手术后24小时,四组血清中Cor、NE、MDA、SP、PGE2、BK、NPY、TNF-α、IL-6、IL-10、NE的含量均较手术前显著升高,血清中SOD、CAT的含量以及外周血中CD3+、CD4+、CD8+T细胞的含量均较手术前显著降低且N组、R组、N+R组血清中Cor、NE、MDA、SP、PGE2、BK、NPY、TNF-α、IL-6、IL-10的含量均显著低于对照组,血清中SOD、CAT的含量以及外周血中CD3+、CD4+、CD8+T细胞的含量均显著高于对照组;N+R组血清中Cor、NE、MDA、SP、PGE2、BK、NPY、TNF-α、IL-6、IL-10的含量均显著低于N组和R组,血清中SOD、CAT的含量以及外周血中CD3+、CD4+、CD8+T细胞的含量均显著高于N组和R组.结论:纳布啡超前镇痛联合罗哌卡因局部浸润能够减轻小儿术后的切口疼痛及应激反应、改善免疫功能.%Objective:To study the effect of nalbuphine preemptive analgesia combined with ropivacaine local infiltration on postoperative incision pain ,stress response and immune function in children .Methods:Children who received selective lapa-rotomy in Mianyang Central Hospital between August 2015 and August 2017 were selected and randomly divided into control group ,nalbuphine group (N group) ,ropivacaine group (R group) and nalbuphine + ropivacaine group (N+ R group) .The levels of pain and stress-related mediators in serum and the levels of immune cells in peripheral blood were detected before op-eration and 24 hours after operation .Results:24 hours after operation ,serum Cor ,NE ,MDA ,SP ,PGE2 ,BK ,NPY ,TNF-α,IL-6 and IL-10 levels of four groups of children were significantly higher than those before operation while serum SOD and CAT levels as well as peripheral blood CD3+ ,CD4+ and CD8+ T cell levels were significantly lower than those before opera-tion;serum Cor ,NE ,MDA ,SP ,PGE2 ,BK ,NPY ,TNF-α,IL-6 and IL-10 levels of N group ,R group and N+ R group were significantly lower than those of control group while serum SOD and CAT levels as well as peripheral blood CD 3+ ,CD4+and CD8+ T cell levels were significantly higher than those of control group ;serum Cor ,NE ,MDA ,SP ,PGE2 ,BK ,NPY , TNF-α,IL-6 and IL-10 levels of N+R group were significantly lower than those of N group and R group while serum SOD and CAT levels as well as peripheral blood CD3+ ,CD4+ and CD8+ T cell levels were significantly higher than those of N group and R group .Conclusion:Nalbuphine preemptive analgesia combined with ropivacaine local infiltration can reduce the postoperative incision pain and stress response and improve the immune function in children .Key words :