酮咯酸氨丁三醇对肛瘘术后患者疼痛及相关血清学指标的影响

摘要

目的 探讨酮咯酸氨丁三醇对肛瘘术后患者VSA评分、镇痛效果及相关血清学指标的影响.方法 将80例择期行肛瘘切除术患者随机分为曲马多组和酮咯酸氨丁三醇组,每组40例.2组术毕均采用自控镇痛泵镇痛,曲马多组泵内应用曲马多15 mg/kg,酮咯酸氨丁三醇组泵内应用酮咯酸氨丁三醇4 mg/kg,泵注速度2.0mL/h,单次追加量为0.5 mL,锁定时间15 min.观察2组启动镇痛泵即刻、1h、4h、8h、12h、24 h、36 h、48 h视觉模拟疼痛(VAS)评分变化,评价即刻、24 h、48 h镇痛效果,检测即刻、12 h、24 h、48 h肿瘤坏死因子-0α(TNF-α)、白细胞介素-6(IL-6)、5-羟色胺(5-HT)和P物质(PS)水平.结果 曲马多组镇痛8h、12h、24 h、36 h、48 h VAS评分均明显低于即刻(P均＜0.05);酮咯酸氨丁三醇组1h、8h、12 h、24 h、36h、48 h VAS评分均明显低于即刻(P均＜0.05),24 h低于1h(P＜0.05),8h、12h、24 h低于4h(P均＜0.05).酮咯酸氨丁三醇组24 h VAS评分低于曲马多组(P＜0.05).曲马多组48 h镇痛效果明显优于即刻(P＜0.05),酮咯酸氨丁三醇组48 h镇痛效果优于即刻和24 h(P均＜0.05),酮咯酸氨丁三醇组24 h、48 h镇痛效果均优于曲马多组(P均＜0.05).2组12 h、24 h、48 h TNF-α、IL-6、5-HT和PS水平均高于即刻(P均＜0.05).曲马多组48 h TNF-α水平显著高于即刻,低于12h、24 h,差异有统计学意义(P均＜0.05);24 h、48 h IL-6水平均高于12h(P均＜0.05).酮咯酸氨丁三醇组12 h TNF-α水平低于24 h,高于48 h,差异有统计学意义(P均＜0.05);48 h IL-6水平均显著高于12h、24 h(P均＜0.05).酮咯酸氨丁三醇组12h、24 h、48 h TNF-α、IL-6水平均显著低于同期曲马多组(P均＜0.05),5-HT和PS水平与曲马多组比较差异均无统计学意义(P均＞0.05).结论 酮咯酸氨丁三醇对肛瘘术后患者具有良好的镇痛效果,可有效控制炎性反应,减少内源性致痛物质的释放.%Objective It is to investigate the effect of ketorolac tromethamine (KT) on visual analog pain (VAS) scores,nanlgesic effect and correlated serum indexes in the patients after anal fistula operation.Methods 80 cases of patients treated with selective anal fistula resection were randomly divided into tramadol group and KT group,40 cases in each group.Both groups were treated with patient-controlled analgesia pump after operation,tramadol group was given tramadol 15 mg/kg,KT group was given KT 4 mg/kg,the diluted infusion rate was 2 mL/h,a single additional quantity was 0.5 mL,lock time was 15 min.The changes of VAS scores were observed at starting PCIA pump immediately (t0),1 h (t1),4 h(t2),8 h (t3),12h (t4),24 h (t5),36 h (t6),48 h(t7) in both groups,the analgesic effects at t0,t5,t7 were evaluated,the levels of TNF-αt,IL-6,five hydroxytryptamine (5-HT) and substance P (PS) at t0,t4,ts,t7 were determined.Results VAS scores at t3-t7 in tramadol group were lower than those at t0 (P ＜ 0.05),but in KT group the scores at t1-t7 were significantly lower than that at t0,the scores at t5 was lower than that at t1,the scores at t3-t5 were lower than that at t2,the differences were all statistically significant (P ＜ 0.05).VAS scores at t5 in tramadol group were higher than that in KT group (P ＜ 0.05).The analgesic effect at t7 was better than that at t0 in tramadol group(P ＜0.05),the analgesic effect at t7 was better than that at t0 and t5 in KT group(P ＜0.05).The analgesic effect at t5 and t7 was better than that in tramadol group at the same time point(P ＜ 0.05).The levels of TNF-α,IL-6,5-HT and PS were higher than that at t0 in both groups (P ＜ 0.05).In tramadol group,the level of TNF-α at t7 was higher than that at t0,lower than that at t4 and t5,the levels of IL-6 at t5 and t7 were higher than that at t4,the differences were all statistically significant(P ＜ 0.05).In KT group,the level of TNF-α at t4 was lower than that at t5,higher than that at t7,the level of IL-6 at t7 was higher than that at t4 and t5,the differences were statistically significant (P ＜ 0.05).The levels of TNF-α and IL-6 at t4 and t5 in KT group were lower than that in tramadol group at the same time point,the difference was statistically significant (P ＜ 0.05),but there was no difference in the levels of 5-HT and PS between the two groups(P ＞ 0.05).Conclusion Application of KT has a good analgesic effect in the patients after anal fistula operation,which could effectively inhibit inflammatory reaction,reduce the release of endogenous pain substances.