地佐辛复合舒芬太尼患者自控静脉镇痛对腹腔镜肝癌切除术后疼痛和炎症反应的影响

摘要

目的 观察地佐辛复合舒芬太尼患者自控静脉镇痛(PCIA)对腹腔镜肝癌切除术后疼痛和炎症反应的影响.方法 选择择期行腹腔镜下肝癌切除术患者60例,男43例,女17例,年龄18~60岁,体重50~80 kg,ASA Ⅰ或Ⅱ级.采用随机数字表法分为舒芬太尼组(S组)和地佐辛复合舒芬太尼组(DS组),每组30例.术毕使用PCIA,S组配方为舒芬太尼2.0 μg/kg加托烷司琼5 mg加生理盐水配至100 ml,DS组配方为地佐辛0.5 mg/kg加舒芬太尼2.0 μg/kg加托烷司琼5 mg加生理盐水配至100 ml.记录术后4、24、48 h患者VAS评分、数字镇静评分(numeric sedation scale,NSS)以及术后48 h的患者满意度评分.于麻醉诱导前、术毕和术后4、24、48 h采集患者颈内静脉血,采用ELISA法检测血清中TNF-α、IL-2和IL-6 的浓度.记录患者术后48 h内的PCIA泵按压次数及不良反应发生情况.结果 术后4、24、48 h DS组VAS评分明显低于S组(P<0.05);DS组患者满意度评分明显高于S组[(3.9±0.4)分 vs.(2.0±0.5)分] (P<0.05).两组患者各时点NSS评分差异无统计学意义.与麻醉诱导前比较,术后4、24、48 h两组TNF-α和IL-6浓度明显升高,IL-2浓度明显降低(P<0.05);术后24、48 h DS组TNF-α、IL-6 浓度明显低于S组,IL-2浓度明显高于S组(P<0.05).术后48 h内DS组PCIA泵按压次数明显少于S组[(2.0±0.7)次 vs.(7.2±1.3)次] (P<0.05).两组患者不良反应发生率差异无统计学意义.结论 地佐辛0.5 mg/kg复合舒芬太尼2.0 μg/kg患者自控静脉镇痛可提供安全有效的镇痛,并可减轻腹腔镜肝癌切除术后炎症反应.%Objective To observe the effect of patient-controlled intravenous analgesia (PCIA)with dezocine combined with sufentanil on inflammatory response and pain after laparoscopic hepatectomy for hepatocellular carcinoma.Methods Sixty patients (43 males,17 females,aged 18-60 years,ASA grade Ⅰ or Ⅱ) scheduled for laparoscopic hepatectomy for hepatocellular carcinoma were divided into sufentanil group (group S) and dezocine+sufentanil group (group DS) according to the random number table,n=30 each.Patients in group S were given 100 ml normal saline containing sufentanil 2.0 μg/kg and tropisetron 5 mg.Patients in group DS were given 100 ml normal saline containing sufentanil 2.0 μg/kg,dezocine 0.5 mg/kg and tropisetron 5 mg.VAS scores and numeric sedation scale (NSS) scores were recorded at 4,24,48 h after operation and patients' satisfaction scores were recorded at 48 h after operation.The levels of serum tumor necrosis factor-α (TNF-α),interleukin-2 (IL-2),interleukin-6 (IL-6) in blood samples harvested before induction of anesthesia and 0,4,24 and 48 h after operation were measured by ELISA.The times of efficient injection and incidence of adverse effect within 48 h after operation were recored.Results Compared with group S,the VAS scores in group DS were decreased significantly while the satisfaction of patients to analgesia were increased significantly at 4,24,48 h after operation (P<0.05).There were no obvious differences in NSS scores between two groups.Compared with before induction of anesthesia,the concentrations of TNF-α and IL-6 were increased significantly while the concentrations of IL-2 was decreased significantly in both groups at 4,24,48 h after operation (P<0.05).Compared with group S,the concentrations of TNF-α and IL-6 were decreased significantly while the concentrations of IL-2 was increased significantly in group DS at 24,48 h after operation (P<0.05).The times of efficient injection in group DS were less than that in group S significantly within 48 h after operation [(2.0±0.7) times vs.(7.2±1.3) times] (P<0.05).There were no obvious differences in adverse effects between two groups.Conclusion PCIA with dezocine 0.5 mg/kg combined with sufentanil 2.0 μg/kg can alleviate the inflammatory response to some extent in patients after laparoscopic hepatectomy for hepatocellular carcinoma,and it can offer a safe and effective analgesic effect.