目的 比較地佐辛與舒芬太尼經(jīng)靜脈患者自控鎮(zhèn)痛（PCIA）給藥對食管癌患者術(shù)后的鎮(zhèn)痛效果。方法 116例擇期行食管癌根治術(shù)的患者隨機(jī)分為地佐辛組（n=58）和舒芬太尼組（n=58），兩組患者麻醉方法及麻醉藥物使用均相同，術(shù)畢給予PCIA，地佐辛組藥物為0.8 mg/kg地佐辛和6 mg托烷司瓊用生理鹽水配制成100 mL，舒芬太尼組藥物為舒芬太尼2.5 μg/kg和托烷司瓊6 mg用生理鹽水配制成100 mL。記錄兩組患者術(shù)后48 h內(nèi)PCIA按壓次數(shù)和鎮(zhèn)痛藥物累積消耗量，計(jì)算有效按壓率；分別于術(shù)后6h （T₂）、12 h （T₃）、24 h （T₄）和48 h （T₅）評估疼痛視覺模擬量表（VAS）評分，分別于術(shù)前（T₀）、T₁、T₃、T₄和T₅時(shí)檢測T細(xì)胞亞群CD3⁺、CD4⁺、CD8⁺和NK細(xì)胞，記錄兩組患者術(shù)后不良反應(yīng)發(fā)生情況。結(jié)果 地佐辛組患者術(shù)后48 h內(nèi)按壓次數(shù)和鎮(zhèn)痛藥物累積消耗量分別為（5.1±2.2）次和（60.6±11.2） mL，低于舒芬太尼組（7.2±2.6）次和（88.8±9.1） mL （P<0.05）；地佐辛組患者T_2~5時(shí)安靜時(shí)VAS評分[（2.1±0.9）、（1.9±0.6）、（2.0±0.5）、（1.7±0.4）分]和活動(dòng)時(shí)VAS評分[（2.6±1.1）、（2.2±0.8）、（2.3±0.7）、（1.9±0.8）分]均低于舒芬太尼組（P<0.05）；與舒芬太尼組相比，地佐辛組患者T_3~5時(shí)CD3⁺細(xì)胞[（57.8±9.2）%、（62.3±7.8）%、（66.3±9.5）%]均升高，T₃時(shí)CD4⁺[（27.8 ±6.8）%]升高，T_3~4時(shí)CD4⁺/CD8⁺比值[（1.15±0.62）、（1.24±0.52）]和NK細(xì)胞[（20.2±6.9）%、（21.3±4.9）%]升高，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）；地佐辛組患者術(shù)后總不良反應(yīng)發(fā)生率22.4%，顯著低于舒芬太尼組的39.7%（P<0.05）。結(jié)論 與舒芬太尼相比，地佐辛應(yīng)用于食管癌患者術(shù)后鎮(zhèn)痛，可提高鎮(zhèn)痛效果、改善患者機(jī)體細(xì)胞免疫功能、減少術(shù)后不良反應(yīng)的發(fā)生。

Objective To investigate the differences of dezocine on postoperative analgesia and cellular immune function in patients with esophageal cancer.Methods A total of 116 cases of patients undergoing elective esophageal cancer surgery were randomly divided into dezocine group (n=58) and sufentanil group (n=58).Patients in the two groups were taken the same anesthesia method and anesthesia drugs.After surgery,the patients in the two groups were connected PCIA.The formula in the dezocine group:dezocine 0.8 mg/kg and sufentanil tropisetron 6 mg were formulated with saline for 100 mL,and in the sufentanil group:sufentanil 2.5 μg/kg and 6 mg tropane were formulated with saline for 100 mL.The number of PCIA compressions and the cumulative consumption of analgesic drugs within 48 h after surgery were recorded,and the effective compression rate was calculated.After surgery 6 h (T₂),12 h (T₃),24 h (T₄) and 48 h (T₅),respectively.The VAS scores in different points were assessed by using pain visual analog scale (VAS).Respectively,before surgery (T₀),T₁,T₃,T₄ and T₅,the T cell subsets of CD3⁺,CD4⁺,CD8⁺ and NK cells were detected.The adverse reactions after surgery in the two groups were recorded.Results The number of PCIA compressions and the cumulative consumption of analgesic drugs within 48 h after surgery were (5.1±2.2) times and (60.6±11.2) mL,respectively,which were less than the sufentanil group,which were (7.2±2.6) times and (88.8±9.1) mL,respectively,the differences were statistically significant (P<0.05).The VAS scores in the dezocine group at T_2~5[(2.1±0.9),(1.9±0.6),(2.0±0.5),(1.7±0.4)]and[(2.6±1.1),(2.2±0.8),(2.3±0.7),(1.9±0.8)]were lower than the sufentanil group,the differences were statistically significant (P<0.05).Compared with the sufentanil group,the CD3⁺ cells in the dezocine group at T_3-5[(57.8±9.2)%,(62.3±7.8)%,(66.3±9.5)%]were increased,CD4⁺cells at T3[(27.8±6.8)%]was increased,the proportions of CD4⁺/CD8⁺[(1.15±0.62),(1.24±0.52)]and NK cells[(20.2±6.9)%,(21.3±4.9)%]at T_3-4 were increased,the differences were statistically significant (P<0.05).The total incidence of adverse reactions in the dezocine group was 22.4%,which was significantly lower than the sufentanil group,which was 39.7%,the difference was statistically significant (P<0.05).Conclusion Compared with sufentanil,dezocine applied in postoperative analgesia of patients with esophageal cancer could improve the analgesic effect,improve the patients'immune function,and reduce the incidence of postoperative adverse reactions.

河南省2015年科技發(fā)展計(jì)劃項(xiàng)目（152300410164）