高乌甲素联合芬太尼用于神经外科患者术后镇痛

摘要

目的 观察高乌甲素(Lappaconitine,LA)联合芬太尼用于神经外科患者自控静脉镇痛(PCIA)的效果,探讨其对神经外科术后应激反应及机体免疫功能的影响.方法 30例择期开颅手术的患者,年龄28～63岁,ASA Ⅰ～Ⅱ级,随机分为两组.芬太尼组(Ⅰ组,n=15):术后镇痛给予芬太尼12.0μg/kg+昂丹司琼0.15 mg/kg;高乌甲素组(Ⅱ组,n=15):术后镇痛给予高乌甲素0.4 mg/kg+芬太尼6.0 μg/kg+昂丹司琼0.15 mg/kg.手术结束前30 min,负荷镇痛Ⅰ组静脉给予芬太尼1.0 μg/kg+昂丹司琼0.08 mg/kg,Ⅱ组静脉给予高乌甲素0.08 mg/kg+昂丹司琼0.08 mg/kg,手术结束后即刻连接静脉镇痛泵.分别记录术后6h、24 h和48 h各时间点的VAS评分,Ramsay评分及不良反应发生情况；用放射免疫法检测术后6h和24h外周静脉血血浆内皮素-l(ET-1)和白细胞介素-2 (IL-2)表达水平.结果 与Ⅰ组相比,Ⅱ组术后6h、24 h和48 h VAS评分和Ramsay镇静评分之间差异无统计学意义.与Ⅰ组相比,Ⅱ组术后恶心呕吐评分显著降低(P＜0.05)；Ⅰ组有呼吸抑制发生(P＜0.05).与术前相比,Ⅰ组和Ⅱ组术后6h和24 h血浆ET-1水平显著降低(P＜0.05)；与Ⅰ组相比,Ⅱ组术后6h和24 h血浆ET-1水平无明显变化.与术前相比,Ⅰ组术后6h和24h血清IL-2水平显著降低(P＜0.05)；与Ⅰ组相比,Ⅱ组术后6h和24h血清IL-2水平显著升高(P＜0.05).结论 高乌甲素联合芬太尼用于神经外科开颅手术患者自控静脉镇痛效果与单纯使用芬太尼相似,并降低恶心呕吐和呼吸抑制发生；同时能够抑制机体应激反应,增强机体的免疫功能.%Objective To investigate the effects of lappaconitine combined with fentanyl on patient-con trolled intravenous analgesia (PCIA) in patients undergoing craniotomy, and to explore its impact on the stress re sponse and immunity. Methods Thirty patients of ASA I - H aged 28-63 years old scheduled for elective cranioto my were randomly divided into two groups: Group I (treated by PCIA with 12.0 μg/kg fentanyl+0.15 mg/kg ondanse tron) and Group Ⅱ (treated by PCIA with 0.4 mg/kg lappaconitine+6.0 |μg/kg fentanyl+0.15 mg/kg ondansetron. Thirty minutes before the end of the surgery, patients were given 1.0 μg/kg Fentanyl combined with 0.08 mg/kg ondansetron in group I and 0.08 mg/kg lappaconitine combined with 0.08 mg/kg ondansetron in group H, and then PCIA was ap plied. Visual analgesia scale (VAS), Rasmay scale and side effects were recorded at 6 h, 24 h and 48 h after operation. Blood samples were collected before anesthesia and at 6 h and 24 h after operation for detection of plasma endothe lin-1 (ET-1) and interleukin-2 (IL-2) levels using radio immunoassay (RIA). Results There were no statistically significant difference of VAS scores and Ramsay scores at 6 h, 24 h and 48 h after operation between two groups. Group II had significantly lower nausea and vomiting scores than group I (P<0.05). Two cases of respiratory depres sion were found in group I. After operation, plasma ET-1 level in both group I and group II were significantly low er (P<0.05), with no statistically significant difference between the two groups. Levels ofIL-2 in group I de creased significantly after operation (P<0.05), and that in Group Ⅱ was significantly higher than that in group I (P<0.05 ). Conclusion For patients undergoing craniotomy, combined application of lappaconitine and fentanyl in PCIA can results in similar analgesic effect with single use of fentanyl, but also it can suppress the stress response and increase the immunological function related to postoperative pain.