预注不同种类镇痛药物对肾癌根治术中应激反应的影响  

Effect of Pre-injection of Different Analgesic Drugs on Stress Response of Patients Undergoing Radical Nephrectomy

作　　者：任利东[1] 陈晓光[2] 

机构地区：[1]大连市中心医院麻醉科,大连116033 [2]中国医科大学附属第一医院麻醉科,沈阳110001

出　　处：《中国医科大学学报》2011年第1期79-82,共4页Journal of China Medical University

摘　　要：目的评价预先联合使用不同种类镇痛药物对肾癌根治术中应激反应的影响及对舒芬太尼的节俭作用。方法 60例ASAⅠ～Ⅱ级择期行肾癌根治术患者,随机分为4组(n=15):麻醉诱导前10min,Ⅱ组氟比洛芬酯1.5mg/kg和曲马多1.5mg/kg,Ⅲ组氯胺酮0.25mg/kg和氟比洛芬酯1.5mg/kg,Ⅳ组氯胺酮0.25mg/kg和曲马多1.5mg/kg,3组均静脉给药,Ⅰ组静脉注射等量生理盐水。采集给予实验药物前(T1)和切皮后1h(T2)、2h(T3)各时刻静脉血测定血浆细胞因子白介素6(IL-6)和血糖浓度;记录入室后10min(M0)、给予实验药物时(M1)、插管后1min(M2)、切皮后5min(M3)、切皮后1h(M4)、切皮后2h(M5)、出麻醉后恢复室时(M6)各时刻心率(HR)和平均动脉压(MAP);记录舒芬太尼使用量。结果 4组患者术前血糖和IL-6浓度无差异(P>0.05);T2、T3时刻,Ⅱ、Ⅲ、Ⅳ组的血糖和IL-6浓度值与Ⅰ组相比差异有显著意义(P<0.05);Ⅲ、Ⅳ组术中舒芬太尼用量明显少于Ⅰ组(P<0.05)。术中Ⅰ组MAP、HR变化波动幅度明显强于其他3组。结论术前联合使用不同种类镇痛药物可更好地抑制术中应激反应,减少IL-6的生成;更利于维持术中血流动力学稳定;减少术中舒芬太尼使用量。Objective To observe the effects of pre-injection of different analgesic drugs on stress response of patients undergoing radical nephrectomy and the sufentani-sparing effect.Methods Sixty adult patients （ASA Ⅰ-Ⅱ） scheduled to take radical nephrectomy were randomly divided into four groups （15 cases in each group）.Before the induction of anesthesia,flurbiprofen axetil （1.5 mg/kg） and tramadol （1.5 mg/kg） was given in group Ⅱ;Ketamine （0.25 mg/kg） and flurbiprofen axetil （1.5 mg/kg） was administered in group Ⅲ;Ketamine （0.25 mg/kg） and tramadol（1.5 mg/kg） were injected in group Ⅳ;equivalent dose of 0.9% NaCl was injected as control in groupⅠ.Intravenous anesthetic consumption was recorded during the surgery.Serum level of IL-6 and blood sugar were measured at 10 min before the induction of anesthesia （T1）,60 min（T2）,120 min（T3） after incision and requirements of Sufentanil during surgery.The values of mean artery pressure （MAP） and heart rate（HR） were recorded at M0（10 min after into the operating room）,M1（the moment of injection drug ）,M2（the moment of tracheal intubation）,M3（5 min after incision ）,M4（1 h after incision ）、M5（2 h after incision ）,and M6（out of the PACU）.Results There were no significant differences in the level of serum IL-6 and blood sugar between the four groups at the T1,but the levels of serum IL-6 and blood sugar were lower in groupⅡ,Ⅲ,and Ⅳ at the T2,T3 than those in groupⅠ（P 〈 0.05）.Requirements of Sufentanil were significantly less in group Ⅲ,Ⅳ than that in groupⅠ（P 〈 0.05）.Conclusion Pre-injection of different analgesic drugs could effectively decrease the serum levels of IL-6,reduce the requirements of Sufentanil during surgery and restrain the stress response obviously.

关 键 词：应激 白介素-6 血糖 氟比洛芬酯 曲马多 氯胺酮 舒芬太尼 

分 类 号：R971.2[医药卫生—药品]