芬太尼、吗啡自控静脉镇痛对胃癌根治术患者全身炎性反应综合征演变的影响  

Effects of Fentanyl and Morphia on Systemic Inflammatory Response Syndrome in Patients with Carcinoma of Stomach

作　　者：侯宝君[1] 史计月[1] 张洪林[2] 安静[1] 周琨[2] 

机构地区：[1]河北工程大学附属医院麻醉科,河北邯郸056029 [2]河北工程大学附属医院外科,河北邯郸056029

出　　处：《天津医药》2007年第4期265-267,共3页Tianjin Medical Journal

基　　金：河北省科技攻关课题(项目编号:20042761484);河北省医学重点研究课题(项目编号:05330)

摘　　要：目的:观察胃癌根治术后患者芬太尼、吗啡自控静脉镇痛(PCIA)对全身炎性反应综合征(SIRS)病情演变的影响。方法:60例静脉与吸入复合全身麻醉下行胃癌根治术后患者随机分为2组,F组(芬太尼15μg/kg)和M组(吗啡0.15mg/kg),辅助用药均为利多卡因10mg/kg、咪哒唑仑0.4mg/kg和地塞米松0.3mg/kg,每组均为30例。分别于术后4、24、48和72h应用SIRS评分和PH镇痛效果评分评估SIRS演变和镇痛效果,采用放免法随机测定每组6例患者各时间点血清肿瘤坏死因子-α(TNF-α)、白介素-2(IL-2)、白介素-6(IL-6)浓度。结果:术后各时间点SIRS评分F组均低于M组,2组差异均有统计学意义(P<0.05);而PH镇痛效果评分各时间2组间差异无统计学意义;TNF-α、IL-2、IL-6浓度在各时间点F组显著高于M组,差异均有统计学意义(P<0.05或P<0.01)。术后皮肤瘙痒、恶心呕吐、术后排气时间M组显著高于F组(P<0.05或P<0.01)。结论:胃癌根治术后吗啡PCIA镇痛效果与芬太尼相近,但因其抑制肠功能恢复,加剧SIRS演变,增加相关并发症发生,不利于患者术后的康复。Objective： To observe the effects of fentanyl and morphia intravenously to ease pain after operation on the development of systemic inflammatory response syndrome （SIRS） in patients with carcinoma of stomach. Methods： Sixty cases received radical operation for carcinoma of stomach under vein-inhale combined general anesthesia were randomly divided into two groups according to selected drugs of patient-controlled intravenous analgesia（PCIA）, 30 cases with fentanyl 15μg/kg （group A）, 30 cases with morphia 0.15mg/kg （group B）. The adjuvants for both groups were lidocaine （10 mg/kg）, midazolarn （0.4 mg/kg） and decaspray （0.3 mg/kg）. The data of SIRS and PH scores were collected at 4,24,48 and 72 h after operation to evaluate the development of SIRS and the result of easing pain. The densities of TNF-α, IL-2 and IL-6 in blood for 6 cases of each group were measured. Results： The scores of SIRS of group A at each time point were all notably lower than those of group B （P 〈 0.05） while the effects of PH in group B were overmatched group A, but the difference had no statistic meaning. The densities of TNF-α and IL-2 and IL-6 in two groups were almost the same at 4 and 24 h after operation but notably higher in group B at 48 and 72 h after operation （P 〈 0.05）. The complications after operation including cutaneous pruritus, nausea, vomit and late exhausting time after operation were notably higher in group B compared with those of group A （P 〈 0.05）. Conclusion： Although morphia has better effects easing of pain after operation for carcinoma of stomach it can also delay the recover of intestine function, make the SIRS even worse and increase complications, and so go against the recover of the patients.

关 键 词：癌 胃肿瘤 吗啡 芬太尼 镇痛 脓毒症综合征 

分 类 号：R59[医药卫生—内科学]