地佐辛用于经腹妇科恶性肿瘤根治术术后静脉自控镇痛的效果及其对炎性因子的影响

摘要

目的 观察地佐辛用于经腹妇科恶性肿瘤根治术术后患者静脉自控镇痛(PCIA)的效果及其对炎性因子的影响.方法 选取2013年10月至2014年6月江苏省肿瘤医院于全身麻醉下行经腹妇科恶性肿瘤根治术的患者50例,随机分地佐辛组(25例)和芬太尼组(25例).地佐辛组术后镇痛泵配方为地佐辛(0.8 mg/kg)+托烷司琼(6 mg)加入0.9％氯化钠注射液至100 ml;芬太尼组术后镇痛泵配方为芬太尼(0.01 mg/kg)+托烷司琼(6 mg)加入0.9％氯化钠注射液至100 ml.记录麻醉苏醒时,术后2、6、24及48 h安静及活动状态下疼痛视觉模拟量表(VAS)评分、Ramsay镇静评分;记录麻醉诱导前、麻醉苏醒时、术后24和48 h血压、心率、呼吸频率及脉搏血氧饱和度(SpO2),检测血清白细胞介素(IL)6、IL-10及肿瘤坏死因子α(TNF-d)水平.结果 2组各时点血压、心率、呼吸频率及Sp02差异均无统计学意义(P＞0.05).地佐辛组术后2、6、24 h静息及运动状态下VAS评分均明显低于芬太尼组[静息状态:0(0,1)分比1(1,2)分、1(0,1)分比1(1,1)分、1(0,1)分比1(1,1)分;运动状态:3(2,3)分比3(3,4)分、3(2,3)分比3(3,4)分、2(2,3)分比3(2,3)分](均P＜0.05),麻醉苏醒时及术后48 h安静及运动状态下VAS评分差异无统计学意义(均P＞0.05).Ramsay镇静评分各时点2组间差异无统计学意义(均P＞0.05).地佐辛组术后24和48 h IL-6水平明显低于、IL-10水平明显高于芬太尼组[IL-6:(100±39) ng/L比(124 ±42) ng/L、(84 ±29) ng/L比(108±33) ng/L,IL-10:(28.8±8.0)ng/L比(21.5-6.9) ng/L、(25.5±4.1)ng/L比(17.5±5.3) ng/L](均P＜0.05),地佐辛组术后24 h TNF-α水平明显低于芬太尼组[(227±69) ng/L比(323±109) ng/L,P＜0.05].地佐辛组1例(4.0％)发生恶心、1例(4.0％)发生呕吐,芬太尼组3例(12.0％)发生恶心、2例(8.0％)发生呕吐,2组患者均未发生嗜睡、瘙痒及呼吸抑制.结论 与芬太尼相比,地佐辛PCIA用于妇科恶性肿瘤根治术患者术后镇痛效果更满意,可减轻患者术后炎性反应,且不良反应发生率更低.%Objective To observe the effect of dezocine on patient controlled intravenous analgesia (PCIA) and inflammatory cytokines in patients with gynecologic malignant tumor after transabdominal radical operation.Methods Fifty patients with gynecologic malignant tumor who underwent transabdominal radical operation under general anaesthetic from October 2013 to June 2014 were enrolled and randomly divided into dezocine group (25 cases) and fentanyl group (25 cases).Dezocine (0.8 mg/kg) + tropisetron (6 mg dissolved in 100 ml 0.9％ sodium chloride injection)were contained in the PCIA pump in dezocine group and fentanyl (0.01 mg/kg) + tropisetron (6 mg dissolved in 100 ml 0.9％ sodium chloride injection) were contained in the PCIA pump in fentanyl group.The pain visual analogue scale (VAS) and Ramsay sedation score were recorded at the time of anesthesia recovery, 2, 6, 24 and 48 h after surgery.The blood pressure, heart rate (HR), respiration rate (RR) and pulse oxygen saturation (SpO2), levels of interleukin (IL)-6, IL-10 and tumor necrosis factor (TNF)-α were measured before anesthesia induction, at the time of anesthesia recovery, 24 and 48 h after surgery.Results The blood pressure, HR, RR and SpO2 showed no significantly differences between the two groups at all the time points.The VAS scores at resting and motion state in dezocine group were significantly higher than those in fentanyl group 2, 6 and 24 h after surgery[resting state: 0(0, 1) scores vs 1(1, 2) scores, 1(0, 1) scores vs 1(1, 1) scores, 1(0, 1) scores vs 1 (1, 1) scores;motion state : 3 (2, 3) scores vs 3 (3, 4) scores, 3 (2, 3) scores vs 3 (3, 4) scores, 2(2, 3) scores vs 3(2, 3) scores] (all P ＜0.05);while the scores at the time of anesthesia recovery and 48 h after surgery showed no significantly differences between the two groups [resting state: (0.5 ± 0.7) scores vs (0.8 ± 0.7) scores, (0.5 ± 0.6) scores vs (0.7 ± 0.6) scores;motion state : (2.5 ± 0.6) scores vs (2.8 ± 0.7) scores,(2.5 ± 0.6) scores vs (2.7 ± 0.7) scores vs] (all P ＞ 0.05).No significantly differences in Ramsay sedation score were found between the two groups at all time points (all P ＞ 0.05).The level of IL-6 was significantly lower and the level of IL-10 was significantly higher in dezocine group than those in fentanyl group 24 and 48 h after surgery [IL-6: (100±39) ng/L vs (124±42) ng/L, (84±29) ng/L vs (108±33) ng/L;IL-10: (28.8±8.0) ng/L vs (21.5 ± 6.9) ng/L, (25.5 ± 4.1) ng/L vs (17.5 ± 5.3) ng/L] (P ＜ 0.05);the level of TNF-α in dezocine group was significantly lower than that in fentanyl group 24 h after surgery [(227 ±69) pg/ml vs (323 ± 109) pg/ml](P ＜0.05).Incidences of nausea and vomiting were 4.0％ (1/25) and 4.0％ (1/25) in dezocine group, 12.0％ (3/25) and 8.0％ (2/25) in fentanyl group;no drowsiness, pruritus and respiratory depression were observed in both groups.Conclusion Compared with fentanyl, postoperative analgesia with dezocine provides more satisfactory analgesia effect and is helpful to reduce the inflammatory response, with lower incidence of adverse reactions in patients of gynecologic malignant tumor.