ABSTRACT
Objective To compare the effect of oxycodone,sufentanil and fentanyl on immune function in patients with colon cancer under postoperative analgesia,provide guidance and basis for clinical medication.Methods Ninety patients 49 males and 41 females,aged <65 years,ASA physi-cal status Ⅰ or Ⅱ,were enrolled and randomly divided into 3 groups using a random number table (n=30):oxycodone group (group O),sufentanil group (group SF)and fentanyl group (group F).All patients underwent the same way to maintain anesthesia.The PCIA pump recipe were as follows:group O,oxycodone 2 mg/kg+granisetron 3 mg,added normal saline to 100 ml;group SF,sufen-tanil 0.002 mg/kg+granisetron 3 mg,added normal saline to 100 ml;group F,fentanyl 0.02 mg/kg+granisetron 3 mg,added normal saline to 100 ml;The background volume of PCIA electronic pump was 2 ml/h,the amount of each press was 2 ml,the lock time was 1 5 min,the pump time lasted for 24 h and maintained for 2 days after operation.The percentage of CD4+,CD8+and NK cells in venous blood were recorded at the end of surgery,6 h,12 h,24 h and 48 h after surgery.Results In CD4+,in the time points of 6 h,12 h,24 h after surgery,it was significantly higher in group O than that in groups SF and F (P<0.05);CD8+in group O was higher than that of group F,and CD8+in group F was higher than group SF at the time of 6 h after surgery.The group O was significantly higher than that of the groups SF and F at the times of 12 h,24 h after surgery (P<0.05);In NK cells,at the time points of 12 h,24 h and 48 h after surgery,it was significantly higher in group O than in groups SF and F (P<0.05).Conclusion Three analgesic drugs caused decline in immune function.Sufentanil and fentanyl have the similar effects on immunity,but oxycodone have a relatively small effect on immunity.Oxycodone is a more appropriate analgesic drug for colon cancer under postoperative analgesia.
ABSTRACT
Objective To observe the effect of ultrasound-guided transversus abdominis plane block combined with diclofenac sodium suppository in anus on postoperative analgesia and early recov-ery after laparoscopic hysterectomy.Methods Sixty-six patients of laparoscopic hysterectomy,aged 40-60 years,were randomly divided into group T and group D,33 cases in each group.Group T used ultrasound-guided bilateral transversus abdominis plane (TAP)block after surgery.Group D used TAP block and diclofenac sodium suppositories in anus.All patients received PCIA.Postoperative 24 h sufentanil dosage out of analgesia pump and the effective press times were recorded.The incidence of dysphoria,nausea and vomit within postoperative 24 h,the time of first out-of-bed activity,the time of first anal exhaust and the time of removing urine tube were measured.The plasma concentra-tion of interleukin-6(IL-6),C reactive protein (CRP)and cortisol (Cor)were recorded at the follow-ing four time points:before anesthesia,just postoperative moment,8 and 12 h after surgery. Results Compared with group T,the sufentanil dosage [(18.6±3.2)μg vs (40.8±5.1)μg]and the effective press times [(9.3±2.2)times vs (20.4±3.5)times]were fewer in group D (P<0.05).The incidence of dysphoria,and nausea and vomit were less in group D compared with group T (P<0.05).The IL-6,CRP and Cor of group D at 12 h were lower than those of group T (P<0.05). But the times of first out-of-bed activity,anal exhaust and removing urine tube in two groups were not significantly different.Conclusion Transversus abdominis plane block combined with diclofenac sodium suppositories in anus can provide safe and effective postoperative analgesia for laparoscopic hysterectomy,and promote the early fast recovery.
ABSTRACT
Objective To evaluate the effects of different doses of fentanyl on the median effective target plasma concentration (EC50) of propofol inhibiting body movement evoked by gastroscopy in the elderly patients.Methods Ninety patients of both sexes,aged 75-89 yr,with a body mass index of 19-25 kg/m2,of ASA physical status Ⅱ or Ⅲ,scheduled for elective gastroscopy,were randomly divided into 3 groups (n =30 each):control group (group C) and different doses of fentanyl groups (F0.5 and F1.0 groups).Fentanyl 0.5 and 1.0 μg/kg were injected intravenously in F0.5 and F1.0 groups,respectively.Propofol was then administered by target-controlled infusion.The initial target plasma concentrations (Cps) of propofol were 2.0,1.5 and 1.0 μg/ml in C,F0.5 and F1.0 groups,respectively.Gastroscopy was performed after the target effect-site and plasma concentrations were balanced.Body movement was defined as movement in head or four extremities during gastroscopy.The target Cp of propofol was determined by up-and-down sequential trial.Each time the Cp increased/decreased by 0.5 μg/ml in the next patient depending on whether or not body movement developed.The EC50 and 95 ％ confidence interval (CI) of propofol inhibiting gastroscopy-evoked body movement were determined using Probit analysis.Results The EC50 (95 ％ CI) of propofol was 2.24 ng/ml (1.67-2.47 ng/ml) in group C,1.79 (1.55-1.95) μg/ml in group F0.5,and 1.13 (1.08-1.62) μg/ml in group F1.0.There was no significant difference in the EC50 of propofol between F0.5 and C groups.The EC50 of propofol was significantly lower in F1.0 group than in C and F0.5 groups.Conclusion When combined with propofol,fentanyl 1.0 μg/kg is recommended for gastroscopy in the elderly patients.
ABSTRACT
Objective To evaluate the effect of age on the median-effective target plasma concentration (EC50) of propofol inhibiting body movement evoked by gastroscopy in the patients.Methods Ninety adult patients of both sexes,of ASA physical status Ⅰ or Ⅱ,with body mass index 19-25 kg/m2,scheduled for elective gastroscopy,were divided into 3 groups according to age (n =30 each):18-39 yr group (Ⅰ group),40-64 yr group (Ⅱ group) and 65-85 yr group (Ⅲ group).In Ⅰ,Ⅱ,Ⅲ groups,propofol was given by target-controlled infusion with the initial target concentrations of 2.5,2.0 and 1.5 μg/ml,respectively,and gastroscopy was performed when the target concentration was achieved.Body movement was defined as the directional movement in head or four extremities during gastroscopy.The target plasma concentration of propofol was determined by up-and-down sequential trial.Each time the plasma concentration of propofol increased/decreased by 0.5 μg/ml in the next patient depending on whether or not body movement developed.The EC50 and 95 ％ confidence interval of propofol inhibiting gastroscopy-evoked body movement were determined using Probit analysis.Results The EC50 (95 ％ confidence interval) of propofol was 4.2(3.8-4.5),4.1(3.7-4.4) and 2.4(1.8-2.7) μg/ml in Ⅰ,Ⅱ and Ⅲ groups,respectively.There was no significant difference in the EC50 of propofol between group Ⅱ and group Ⅰ.The EC50 of propofol was significantly lower in group Ⅲ than in Ⅰ and Ⅱ groups.Conclusion Age affects propofol-induced analgesia in patients with visceral pain,and the potency of propofol inhibiting visceral pain during gastroscopy in the elderly patients is significantly enhanced as compared with that in the young and middle-aged patients.