引用文本：许静红, 王玉丰, 崔晓光, 等. 纳布啡对腹腔镜结直肠癌术后镇痛效果及FOXP3⁺调节性T细胞水平的影响[J/CD]. 消化肿瘤杂志（电子版）, 2025, 17(3):356-363.

作者：许静红1，王玉丰2 ，崔晓光3，陈俏伶3，卓恩挺4，吴开李4，徐夏1

单位：1. 海南医科大学附属三亚中心医院、三亚中心医院（海南省第三人民医院）麻醉手术科，海南 三亚 572000; 2. 海南医科大学附属三亚中心医院、三亚中心医院（海南省第三人民医院）检验科，海南 三亚 572000; 3. 海南医科大学附属第一医院麻醉科，海南 海口 570105; 4. 海南医科大学附属三亚中心医院、三亚中心医院（海南省第三人民医院）胃肠外科，海南 三亚 572000

Authors：Xu Jinghong1, Wang Yufeng2, Cui Xiaoguang3, Chen Qiaoling3, Zhuo Enting4, Wu Kaili4, Xu Xia1

Unit：1. Department of Anesthesia Surgery, Sanya Central Hospital (the Third People's Hospital of Hainan Province), Sanya Central Hospital Affiliated to Hainan Medical University, Sanya 572000，Hainan, China；2. Department of Medical Laboratory, Sanya Central Hospital (the Third People's Hospital of Hainan Province), Sanya Central Hospital Affiliated to Hainan Medical University, Sanya 572000，Hainan, China；3. Department of Anesthesiology, the First Affiliated Hospital of Hainan Medical University, Haikou 570105, Hainan, China；4. Department of Gastrointestinal Surgery, Sanya Central Hospital (the Third People's Hospital of Hainan Province), Sanya Central Hospital Affiliated to Hainan Medical University, Sanya 572000，Hainan, China

摘要：

目的 探讨纳布啡对腹腔镜结直肠癌根治术患者术后镇痛效果、FOXP3⁺调节性T细胞（regulatory T cell, Treg）水平的影响。 方法 选取2022年7月至2024年6月在三亚中心医院（海南省第三人民医院）择期行腹腔镜结直肠癌根治术并自愿行患者自控静脉镇痛（patient-controlled intravenous analgesia, PCIA）的患者60例，采用随机数字表法按1∶1分为纳布啡组和舒芬太尼组，每组各30例。纳布啡组患者接受纳布啡PCIA，舒芬太尼组患者接受舒芬太尼PCIA。比较两组患者术后6 h、18 h、24 h、48 h、72 h咳嗽状态的视觉模拟评分法（visual analogue scale, VAS）评分，术后72 h内PCIA泵按压次数和曲马多使用剂量，常见不良反应发生情况，术后肠道首次排气时间，以及镇痛首量前和术后12 h、24 h、72 h的FOXP3⁺ Treg水平，术前和术后72 h内的炎症指标（淋巴细胞百分比、中性粒细胞百分比和白细胞计数）。 结果 纳布啡组患者术后6 h、18 h、24 h的VAS评分均低于舒芬太尼组（P＜0.05）。术后72 h内纳布啡组PCIA泵按压次数、曲马多使用剂量低于舒芬太尼组（P＜0.05）。两组均未发生呼吸抑制和过敏事件。纳布啡组术后恶心、呕吐、头晕的发生率均低于舒芬太尼组（P＜0.05）。纳布啡组术后肠道首次排气时间短于舒芬太尼组（P＜0.05）。纳布啡组术后12 h、24 h、72 h的FOXP3⁺ Treg水平均低于舒芬太尼组（P＜0.05）。两组患者术前和术后72 h内的淋巴细胞百分比、中性粒细胞百分比和白细胞计数差异均无统计学意义（P＞0.05）。 结论 与舒芬太尼比较，纳布啡对腹腔镜结直肠癌根治术患者的镇痛效果更优，不良反应发生率较低，并可降低术后FOXP3⁺ Treg水平。

关键词：纳布啡；腹腔镜手术；结直肠癌；术后镇痛；FOXP3⁺调节性T细胞

Abstract：

Objective To investigate the effects of nalbuphine on postoperative analgesia and FOXP3⁺ regulatory T cell (Treg) levels in patients undergoing laparoscopic radical resection of colorectal cancer. Method A total of 60 patients scheduled for elective laparoscopic radical resection of colorectal cancer at Sanya Central Hospital (the Third People's Hospital of Hainan Province) from July 2022 to June 2024, who voluntarily received patient-controlled intravenous analgesia (PCIA) were enrolled. Using a random number table, they were allocated at a 1∶1 ratio to either the nalbuphine group (n=30) or the sufentanil group (n=30). The nalbuphine group received nalbuphine PCIA while the sufentanil group received sufentanil PCIA. The following parameters were compared between the two groups: coughing-state visual analogue scale (VAS) scores at 6 h, 18 h, 24 h, 48 h, and 72 h postoperatively, PCIA pressing frequency and tramadol consumption within 72 h postoperatively, incidence of common adverse reactions, time to first postoperative flatus, FOXP3⁺ Treg levels before initial analgesic administration and at 12 h, 24 h, and 72 h postoperatively, and inflammatory markers (lymphocyte percentage, neutrophil percentage, and white blood cell count) preoperatively and within 72 h postoperatively. Result The nalbuphine group exhibited lower VAS scores at 6 h, 18 h, and 24 h postoperatively compared to the sufentanil group (P<0.05). Within 72 h postoperatively, the nalbuphine group demonstrated fewer PCIA presses and lower tramadol consumption (P<0.05). Neither group experienced respiratory depression or allergic reactions. The incidence of nausea, vomiting, and dizziness were all lower in the nalbuphine group than those in the sufentanil group (P<0.05). Time to first postoperative flatus was shorter in the nalbuphine group (P<0.05). FOXP3⁺ Treg levels at 12 h, 24 h, and 72 h postoperatively were all lower in the nalbuphine group than those in the sufentanil group (P<0.05). No statistically significant differences were observed in lymphocyte percentage, neutrophil percentage, or white blood cell count between the two groups preoperatively or within 72 h postoperatively (P>0.05). Conclusion Compared with sufentanil, nalbuphine provides superior postoperative analgesia with fewer adverse reactions and reduces FOXP3⁺ Treg levels in patients undergoing laparoscopic radical resection of colorectal cancer.

Key words：Nalbuphine; Laparoscopic surgery; Colorectal cancer; Postoperative analgesia; FOXP3⁺ regulatory T cell

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