| Objective:To investigate the effects of multimodal analgesia schemes on perioperative analgesia and immune function in patients undergoing thoracoscopic lobectomy.Methods:90 patients with lung resection under thoracoscope,male 51 cases,female39 cases,ages 18 to 65 years old,were randomly divided into 3 groups（each group 30 cases）:control group（group C）:PCIA;Flurbiprofen axetil+PCIA（group P）;Flurbiprofen axetil+TPVB)+PCIA（group M）.Record intraoperative propofol,remifentanil dosage and sufentanil additional dosage,the VAS of postoperative 6,24,48h and number of analgesia pump pressure within 48h.Venous blood samples were collected when patients entry into the operating room（T0）,1 day（T1）,3 days（T2）and 5 days（T3）after operation,and then T lymphocyte subsets（CD3+,CD4+and CD8+）and NK cells were measured by flow cytometry,and the CD4+/CD8+was calculated.Results:Compared with control group,the dosage of remifentanil and sufentanil supplementation in preemptive analgesia group and multimodal analgesia group were significantly decreased（P<0.05）;in preemptive analgesia group,the VAS score at 6h after surgery was significantly decreased（P<0.05）,the percentage of NK cells at T1and the levels of CD3+,CD4+and CD4+/CD8+were significantly increased（P<0.05）;In multimodal analgesia group,the VAS scores at 6 h and 24 h after surgery were significantly decreased（P<0.05）,the analgesia pump was pressed less frequently（P<0.05）,the percentage of NK cells and the levels of CD3+,CD4+,CD4+/CD8+at T1and T2,and the levels of CD3+and CD4+at T3were increased（P<0.05）,and the incidence of postoperative nausea and vomiting was lower（P<0.05）.Conclusion:In the thoracoscopic lobectomy,multimodal analgesia can enhance postoperative analgesia,reduce perioperative opioid dosage,immunosuppression,but do not increase the incidence of postoperative nausea and vomiting.Besides,flurbiprofen ester combined with paravertebral nerve block and PCIA had more perfect analgesia and less effect on immunity. |
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