摘要
目的:围术期有很多因素抑制机体免疫功能,术后疼痛是其中主要因素之一,比较3种不同的术后镇痛技术对患者免疫功能的影响。方法:选择郧阳医学院附属太和医院2004-01/2005-01下腹部手术的患者120例,随机分成3组:阿片类药组,自控静脉镇痛组和自控硬膜外镇痛组,每组40例。阿片类药组按需给杜冷丁75mg。自控静脉镇痛组术后立即给予负荷量吗啡3.0～4.0mg,泵设定为:每次按压静脉注射吗啡1mg,锁定时间6～8min。自控硬膜外镇痛组术后连接镇痛泵设定为:每次按压给3mL混和液(1g/L布比卡因注射液+2mg/L芬太尼)锁定时间10min,背景持续给药6mL/h。在术前、术后4,12,24和48h采用目测类比评分法(VAS)对患者休息和咳嗽时的疼痛程度进行评分,0分为无痛,10为极痛。于术后24,48和72h测定血浆白细胞介素1和白细胞介素6浓度。结果:120例患者均进入结果分析。①各组目测类比评分比较:术后4,12,24h休息和咳嗽时,自控硬膜外镇痛组目测类比评分均明显低于阿片类药组(P<0.05),术后4h休息和咳嗽时自控硬膜外镇痛组评分明显低于自控静脉镇痛组[(2.8±0.7)和(5.4±1.2)分,(4.8±1.6)和(7.1±1.9)分,q=6.12,7.11,P<0.01]。②各组血清白细胞介素1和白细胞介素6含量比较:术后24,48h时,自控硬膜外镇痛组血清白细胞介素1浓度明显低于阿片类药组和自控静脉镇痛组[(2.69±0.67),(3.14±0.78)ng/L比(15.48±3.97),(7.83±1.88)ng/L和(13.29±3.84),(7.65±1.72)ng/L,q=5.18～6.30,P<0.01];术后24,48和72h时,自控硬膜外镇痛组血清白细胞介素6浓度明显低于阿片类药组和自控静脉镇痛组(q=5.11～8.45,P<0.01)。结论:术后采用硬膜外自控给药方式镇痛效果较好,而且能抑制血清白介素1和白介素6的水平,对机体免疫功能有一定改善作用。
AIM： Pospoperative pain is one of the main perioperative factors that restrain the immune function. This paper was to compare the effects of 3 different analgesic methods on the postoperative immune function of patients after surgery.
METHODS： Totally 120 patients scheduled for lower abdominal surgery in the Taihe Hospital affiliated to Yunyang Medical College between January 2004 and January 2005 were randomly divided into three groups according to different analgesic methods after surgery with 40 cases in each group： intermittent opiate group, patient-controlled intravenous analgesia （PCIA） group, and patient-controlled epidural analgesia （PCEA） group. In the PCIA group, the patients were given morphine （3.0-4.0 mg） immediately after surgery, and the pump was set that： 1 mg morphine was venously injected with press for each time, locked time for 6-8 minutes. In the PCEA group, the connected analgesic pump was set that 3 mL mixed liquid （1 g/L bupivacaine injection＋2 mg/L fentanvl） was given for each press, the locked time for 10 minutes, the background administration lasted for 6 mL per hour. The pain degree at rest or coughing was assessed with visual analog scale （VAS） before surgery and at 4, 12, 24 and 48 hours after surgery respectively： 0 as painless, 10 as extremely painful. The levels of serum interleukin-1 and interleukin-6 were measured at 24, 48 and 72 hours after surgery.
RESULTS： All the 120 patients were involved in the analysis of results. ①Comparison of VAS scores： The VAS scores at rest and coughing at 4, 12 and 24 hours after surgery in the PCEA group were obviously lower than those in the intermittent opiate group （P 〈 0.05）, the scores at rest and coughing at 4 hours after surgery in the PCEA group were markedly lower than those in the PCIA group [（2.8±0.7）, （5.4±1.2） points, （4.8±1.6）, （7.1±1.9） points, q=6.12, 7.11, P 〈 0.01]. ②Comparison of levels of serum interleukin-1 and interleukin-6： The levels of serum interleukin-1 at 24 and 48 hours in the PCEA group were obviously lower than those in the intermittent opiate group and PCIA group [（2.69±0.67）, （3.14±0.78） ng/L; （15.48±3.97）, （7.83±1.88） ng/L; （13.29±3.84）, （7.65±1.72） ng/L, q=5.18-6.30, P 〈 0.01]. The levels of serum interleukin-6 at 24, 48 and 72 hours in the PCEA group were obviously lower than those in the intermittent opiate group and PCIA group （q=5.11-8.45, P 〈 0.01）.
CONCLUSION： Patient-controlled epidural analgesic method has good effect, it can inhibit the levels of serum interleukin-1 and interleukin-6, and improve immune function.
出处
《中国临床康复》
CSCD
北大核心
2006年第4期62-64,共3页
Chinese Journal of Clinical Rehabilitation
