Effect Of Nalbuphine On Immune And Inflammation In Patients Undergoing Glioma Surgery

Objective:The purpose of this study was to investigate the effects of different doses of nalbuphine analgesia on perioperative immune cell related indexes(absolute value of CD3+T cells,CD4+T cells,CD8+T cells,NK cells and B lymphocytes)and inflammatory cytokines related indexes(IL-6,TNF-? and IL-10)in patients undergoing glioma surgeryMethods:From February 2019 to November 2019 in the first affiliated hospital of Kunming medical university,a total of 90 cases of glioma resection under general anesthesia were collected.The age of the selected patients was 35-55 years old,gender unlimited,ASA ?-?,BMI 18.5-23.9 kg/m2,The selected patients were randomly divided into three groups:nalbuphine analgesia group(high dose N1 group,low dose N2 group)and control group(C group),30 cases in each group.5 minutes before artery puncture,in N1 group and N2 group,0.2mg/kg and 0.15mg/kg nalbuphine were respectively given by intravenous drop;100 ml normal saline was given by intravenous drop in group C,PCIA was given after extubation in three groups.Operation time,intraoperative blood loss,intraoperative infusion volume and urine volume were recorded;HR and MAP were recorded before anesthesia induction(T0),during radial artery puncture(T1),during endotracheal intubation(T2),during extubation(T4);VAS scores were recorded at the time of extubation(T4),24 hours after operation(T5),48 hours after operation(T6);And the collection of center venous blood 6ml at T0,T3(during skin incision),T4,T5,T6 were injected into vacuum anticoagulant tube and anticoagulant tube respectively.T lymphocyte subsets(CD3+,CD4+,CD8+),NK cells,B lymphocytes,IL-6,TNF-? and IL-10)were measured by flow cytometry.Results:(1)Basic information of patients:there was no significant difference in age,BMI,gender,operation time,intraoperative blood loss,intraoperative infusion volume and urine volume among the three groups(P?0.05).(2)Postoperative VAS score:there was no significant difference among the three groups at T4(P?0.05).Compared with group C,the VAS scores of N1 group and N2 group at T5 and T6 were significantly lower(P?0.05),meanwhile N1 group was lower than N2 group(P?0.05).(3)The changes of HR and MAPComparison within groups:in group C,HR and MAP at T1 and T2 were higher than T0,and the difference was statistically significant(P?0.05).In group N1 and group N2,HR and MAP had no significant difference at each time point(P?0.05).Comparison between groups:compared with group C,HR and MAP of N1 and N2 groups decreased at T1 and T2,and the difference was statistically significant(P?0.05).There was no significant difference about HR and MAP between N1 group and N2 group(P?0.05).(4)The changes of serum inflammatory cytokines(IL-6,TNF-?,IL-10)Comparison within groups:in group C,N1 and N2,compared with T0,the levels of IL-6 and IL-10 at T3,T4,T5 and T6 were significantly higher(P?0.05);In group C,compared with T0,the levels of TNF-? at T3,T4,T5 and T6 were significantly higher(P?0.05);In N1 group,compared with T0,the level of TNF-? decreased at T3,T4 and T5,and the difference was statistically significant(P?0.05),but not at T6(P?0.05);In N2 group,compared with T0,the level of TNF-? increased at T3,T5 and T6,and decreased at T4(P?0.05)Comparison between groups:There was no significant difference in the levels of IL-6,TNF-? and IL-10 between the three groups(P?0.05).Compared with group C,the levels of IL-6,TNF-?,IL-10 at T3,T4,T5,T6 in N1 and N2 groups were lower than group C(P?0.05).The level of IL-6,TNF-? and IL-10 in N1 group was lower than N2 group at T3,T4,T5 and T6(P?0.05).(5)the change of immune cell(CD3+,CD4+,CD8+,NK,B lymphocyte)Comparison within groups:compared with T0,the count of CD3+,CD4+,CD8+,NK and B lymphocyte in group C decreased at T3,T4,T5,T6(P?0.05).In N1 group,compared with T0,the counts of CD3+,NK cells decreased at T3,T4,T5 and T6(P?0.05);The counts of CD4+,CD8+decreased at T3,T4 and T5(P?0.05),there was no significant difference at T6(P?0.05);The counts of B lymphocytes decreased at T3,T4 and T5(P?0.05),and increased at T6(P?0.05).The counts of CD3+,CD4+,CD8+,NK cells decreased at T3,T4,T5,T6 in N2 group(P?0.05);B lymphocytes decreased at T3,T4,T5(P?0.05),and there was no significant difference at T6(P?0.05).Comparison between groups:there was no significant difference among the three groups at T0,T3,T4(P?0.05).The number of CD3+,CD4+,CD8+,NK and B lymphocytes at T5,T6 in N1 and N2 groups were higher than C group(P?0.05),meanwhile N1 group was higher than N2 group(P<0.05),that was N1 group,N2 group and C group were in order from high to low(P?0.05).Conclusion:Using preemptive analgesia and postoperative PCIA with nalbuphine undergoing glioma surgery can produce perfect analgesic effect,effectively maintain hemodynamic stability,effectively reduce inflammatory reaction,and promote the recovery of postoperative immune function.The analgesic effect of preemptive analgesia with 0.2mg/kg of nabufine combined with 2mg/kg of PCIA is more significant.