摘要
Abstract
Objective:To observe the influence about analgesia and adverse reactions and immunologic function of Dexmedetomidine combined with Morphine in PCIA in gastric cancer patients after abdominal operation.Method:From August 2015 to March 2016,112 cases with selective gastrectomy of stomach neoplasms operation in our department were selected,ASA Physical status were Ⅰ-Ⅱ,they were randomly divided into the group C(control group) and group D (Dexmedetomidine group).Each group had 56 cases.The PCIA pump was connected immediately after the end of surgery.Group C administrated with Morphine(100 mg)+Tropisetron HCl(10 mg),and group D administrated with Morphine(82 mg)+Dexmedetomidine(200 μg)+Tropisetron HCl(10 mg).All the anesthetic agents were diluted into 200 ml of 0.9% 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 total amount of Morphine,the number of PCA and successfully control within 24 h and 48 h 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,24 h, 72 h,120 h after operation).Result:The total amount of Morphine,the number of PCA and successfully control within 24 h and 48 h after operation were significantly smaller and the incidences of nausea and vomiting and pruritus were significantly lower in group D than those in group C(P<0.05).No bradycardia, hypotension,over sedation respiratory depression were observed in each group.Compared with the base lines,CD3+,CD4+,CD4+/CD8+ lymphocytes and NK cells of the two groups began to decrease during extubation(P<0.05),and were the lowest at 24 h after operation(P<0.01).In group D,the number of CD3+,CD4+, CD4+/CD8+ lymphocytes and NK cells were recovered nearly to the baseline 72 h after operation,but in group C they were significantly lower than the baseline or that in group D(P<0.05).The whole T cells and NK cells recovered in 120 h after operation in both groups.Conclusion:Dexmedetomidine combined with Morphine in PCIA can achieve the favorable VSA 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.关键词
右美托咪啶/吗啡/静脉自控镇痛/疗效Key words
Dexmedetomidine/Morphine/Patient-controlling intravenous analgesia/Curative effect分类
医药卫生
