摘要
目的:观察妇科术后硬膜外罗哌卡因持续输注联合氯诺昔康PCA的镇痛效应及病人血浆IL-6、IL-10水平的变化。方法:60名妇科经腹子宫全切手术的病人,随机分为三组:氯诺昔康(L)组、吗啡(M)组与对照(C)组。L组与M组采用双泵行PCA治疗,C组采用病房传统的方式镇痛。评估术后五个时间点的视觉模拟评分(VAS)、BCS舒适评分、病人对PCA总体满意度评分,观察并记录镇痛期间有关不良反应。每组(n=10)分别采集切皮前30m in、切皮后2h以及术后4h、24h、48h静脉血,采用酶联免疫吸附法检测血浆IL-6、IL-10水平。结果:L组、M组病人在术后8h、12h、24h的VAS、BCS评分以及镇痛后总体满意度评分明显优于C组。三组病人在切皮后2小时IL-6水平都迅速增高,并在术后24h达峰值,M和C组峰值显著高于L组。C组病人血浆IL-10水平在切皮后2h达峰值,L组与M组则于术后4h达峰值,L和M组的血浆IL-10水平显著高于C组。结论:罗哌卡因硬膜外持续输注与静脉氯诺昔康或吗啡PCA的联合镇痛效果好。静脉氯诺昔康PCA辅助罗哌卡因持续硬膜外镇痛可使术后血浆IL-6水平下调,有利于机体促炎/抗炎细胞因子的平衡。
Objective： The purpose of this study was to study the analgesic effects and plasma levels of IL-6 and IL-10 under patient-controlled intravenous lornoxicam with 0.2% ropivacaine epidurally continues infusion after abdominal hysterectomy. Methods： sixty patients （ASA grade Ⅰ Ⅱ ） undergoint abdominal hysterectomy were randomly divided into three groups （ L, M and C）. In group L （ n = 20） and M （n = 20）, two pumps （A and B） were used for each patient. Pump A was used for continuous epidurally infusion of 0.2% ropivacaine 4ml/h ; pump B was used for patients-controlled intravenous analgesia with 0.08% lornoxicam （group L） or0.1% morphine （group M）. The patients in group C （n =20） received traditional analgesia by muscule injection of pethidine. Postoperative analgesic effect was assessed by visual analog scales （VAS, 0 - 10）, Bruggrmann comfort scale （BCS）, patient＇s appreciation of the PCA, side-effects at different time points. Plasma IL-6 and IL-10 levels were measured before and 2h, 6h, 24h and 48 h after skin incision. Plasma was separated and frozen to perform cytokine analysis using enzyme-linked immunosorbent assay. Results： than group C. However, there was no significant The analgesic effects for group L and M were better difference between group L and M. Among three groups, IL-6 increased immediately after skin incision, peaked at 24 hours postoperatively. The peak levels of IL-6 in group L and M were significant higher than C. For IL-10, group C peaked at 2 hours after skin incision, and group L and M peaked at 4h, which were higher than group C. Conclusion ： continuous infusion of ropivacaine combined with patient-controlled intravenous analgesia with Epidurally lornoxicam has good analgesic effect and could down-modulate postoperative plasma level of interleukin-6.
出处
《中国疼痛医学杂志》
CAS
CSCD
北大核心
2006年第2期72-75,共4页
Chinese Journal of Pain Medicine
基金
广东省卫生厅科研基金资助课题(A1996075)
