双氯芬酸钠栓直肠给药对结肠癌根治术老年患者术后疼痛、炎症反应及术后康复的影响

摘要

Objective To explore the effects of rectal administration of diclofenac sodium suppository on postoperative pain,inflammatory response,and postoperative recovery in elderly patients undergoing colorectal surgery.Methods A total of 60 65-80 years old patients taking colorectal surgery at our hospital from June,2016 to February,2018 were randomly divided into a test group and a control group,30 cases for each group.The test group rectally administrated diclofenac sodium suppository and took postoperative patient-controlled intravenous analgesia (PCIA);and the control group took PCIA.The outcomes of postoperative analgesia were recorded before (T0) and 2 h (T1),6 h (T2),12 h (T3),24 h (T4),and 48 h (T5) after the operation.The levels of plasma interleukin 6 and 8 (IL-6 and IL-8),tumor necrosis factor-alpha (TNF-α),and C-reactive protein (CRP) at T0 to T5 were detected in the two groups.The postoperative recovery was observed in the two groups.Results At T1 to T4,the scores of VAS were lower in test group than in the control group (all P ＜ 0.05).The times of PCA 24 h after the operation were lower and the satisfaction were higher in the test group than in the control group,with statistical differences (P ＜ 0.05).The serum levels of IL-6 at T2-5 were lower,the serum levels of IL-8 at T1-5 were lower,and the serum levels of plasma TNF-αat T2-4 were lower in the test group than in the control group (all P ＜ 0.05).The recovery of intestinal function after the operation and postoperative recovery were better in the test group than in the control group (P ＜ 0.05).Conclusion Preemptive analgesia of rectal administration of diclofenac sodium suppository combined with PCIA for elderly patients with radical colon cancer can relieve their postoperative pain and reduce inflammation,and is helpful for their rapid recovery after surgery.%目的 观察双氯芬酸钠栓直肠给药超前镇痛对结肠癌根治术老年患者术后疼痛、炎症反应及术后康复的影响.方法 选择2016年6月至2018年2月于本院普外科行开腹乙状结肠癌手术老年患者60例,年龄65 ～ 80岁,随机分为研究组和对照组,每组30例.研究组患者应用双氯芬酸钠栓纳肛及术后静脉镇痛泵自控镇痛(PCIA),对照组患者只应用术PCIA.分别于术前(T0)、术后2h(T1)、术后6h (T2)、术后12h (T3)、术后24h (T4)及术后48h (T5)时间点观察两组患者的术后镇痛效果;分别于T0～T5时测定两组患者血浆白细胞介素6、8(IL-6、IL-8)、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)水平;观察两组患者术后恢复情况.结果 与对照组比较,T1-4时研究组患者VAS评分均明显降低(均P＜ 0.05).与对照组比较,研究组患者术后24 h内PCA按压次数明显减少,而患者满意度明显升高,组间比较差异均有统计学意义(均P＜ 0.05).与对照组比较,T2-5时研究组患者血清IL-6水平明显降低(P＜0.05),T1-5时研究组患者血清IL-8水平明显降低(P＜0.05),T2-4时研究组患者血清TNF-α水平明显降低(P＜0.05).研究组患者术后肠功能恢复情况和术后康复情况亦优于对照组(均P＜ 0.05).结论 双氯芬酸钠栓直肠给药超前镇痛联合PCIA可减轻结肠癌根治术老年患者的术后疼痛,减轻炎症反应,有利于促进患者术后快速康复.