Clinical Study With Analgesia Related Media And On Immune Function For Target-controlled Infusion (TCI) Of Sufentanil In Patients After Laparoscopic Surgery

Objective: To observation the efficacy of sufentanil target controlled infusion techniques analgesia on immune function and related media in patients after gynecological surgery,and to provide evidence for clinical application of target controlled infusion analgesia.Methods: Thirty cases of patients with malignant tumors of the lower abdomen,elective laparoscopic radical surgery,ASA I-II,Age 45-65 years,who were randomly and double-blindly divided into 2 groups: Group A(TCI,n=15):The original target plasma concentration(Cp)of sufentanil was start up 0.1ng/ml in group A,the pain generation which Prince-Henry scores is 3,plasma concentration once increased 0.01ng/ml,Each time the(TCI)pump is locked for interval 15 minutes.Group B(PCIA,n=15):The PCIA rate was 3?g/h,bolus of 3?g when the pain generation which Prince-Henry scores is 3,Each time the PCIA pump is locked for interval 15 minutes.Continuous intravenous use of target controlled infusion of propofol and sufentanil during operation,postoperative intravenous analgesia with sufentanil,Set up the postoperative analgesia pump when at Prince-Henry scores get 3 meanwhile Ramsay sedation score achieve 2 after extubation.Record T1-T6 point PHS,Rassy,basic life signs,before the start of analgesic pump(T0)and the analgesia pump set on(T1),at 1h(T2),2h(T3),4h(T4),8h(T5),and 16h(T6)after the analgesia pump was opened.The total dose of sufentanil and the incidence of adverse effects were recorded during postoperative analgesia.The concerntration of substance P and beta endorphin were measured before anesthesia,T0 and T4?T6,The concerntration of CD4+,CD8+ and CD4+/CD8+T lymphocyte subsets were measured before anesthesia and after operation,and 16 h after surgery.Results :(1)There was no significant difference of SBP?DBP,HR,RR,and Sp O2 between two groups(P>0.05).(2)At T2,T5,T6,the Prince-Henry score of PCIA group was significantly higher than TCI group(P<0.05).(3)Postoperative analgesia 16 h sufentanil dosage in group B was less than group A(P<0.05).(4)At T6,the P concentration in the A group was lower than that in the B group,which has a statistically significant(P<0.05).Compared with before anesthesia,the concentration of P in A and B group increased at T0 and T4(P<0.05).(5)There was no significant difference in the concentration of beta endorphin between the two groups(P>0.05).Compared with before anesthesia,T0,T4,T6 the concentrations of beta endorphin were significantly increased in A and B group(P<0.05).(6)Compared with before anesthesia,the concentration of CD4+ lymphocyte subsets in A and B group decreased at T0 and T6(P<0.05).There was no significant difference in the concentrations of CD8+ and CD4+/CD8+ lymphocyte subsets between two groups(P>0.05).Conclusion: Applying TCI to sufentanil postoperative analgesia after laparoscopic surgery,the overall process of analgesia presented to be effective and safety.It can reduce the concentrations of substance P,The concentrations of beta endorphin was not significantly increased,and the postoperative stress response was alleviated;it can slightly reduce the concentrations of the postoperative CD4+ lymphocytes,CD8+,CD4+/CD8+ lymphocyte subsets have little effect,the need for further research on immune function.And in the absence of additional side effects,with more perfect analgesia.