多模式超前镇痛对腹式全子宫切除术患者应激反应和炎性因子的影响  

Effects of Multimodal Preemptive Analgesia on Stress Response and Inflammatory Factors of Patients with Abdominal Hysterectomy

作　　者：陈建庆[1] 温来友[1] 缪建中[1] 胡永明[1] 吴震[1] 薛瑞萍[1] 

机构地区：[1]东南大学医学院附属江阴医院麻醉科,江苏江阴214400

出　　处：《中国药房》2014年第26期2439-2441,共3页China Pharmacy

基　　金：无锡市科技局项目(No.锡科农〔2010〕150号)

摘　　要：目的:探讨多模式超前镇痛对腹式全子宫切除术患者应激反应和炎性因子的影响。方法:选择125例腹式全子宫切除术患者,均在腰硬联合麻醉下手术,随机均分为对照组(C组)、超前镇痛Ⅰ组(P1组)、超前镇痛Ⅱ组(P2组)、超前镇痛Ⅲ组(P3组)、术后镇痛组(PO组)。C组术前后不给予药物;P1组术前静脉注射氟比洛芬酯和硬膜外腔注射芬太尼+氯胺酮;P2组术前静脉注射氟比洛芬酯,术毕硬膜外腔注射芬太尼+氯胺酮;P3组术前硬膜外腔注射芬太尼+氯胺酮,术毕静脉注射氟比洛芬酯;PO组术毕静脉注射氟比洛芬酯,硬膜外腔注射芬太尼+氯胺酮。观察各组术前与术后第1天、第2天的皮质醇(Cor)、血糖(Glu)和白介素6(IL-6)、肿瘤坏死因子α(TNF-α)浓度。结果:各组术前Cor、Glu和IL-6、TNF-α浓度差异无统计学意义(P>0.05)。术后第1、2天,P1、P2、P3、PO组的Cor、Glu和IL-6、TNF-α浓度明显低于C组(P<0.05),而P2、P3组的Cor、Glu和IL-6、TNF-α浓度显著低于P1、PO组(P<0.05)。结论:多模式超前镇痛能有效抑制腹式全子宫切除术患者的应激反应,抗炎效果显著。OBJECTIVE： To investigate the effects of multimodal preemptive analgesia on stress response and inflammatory factors of patients with abdominal hysterectomy. METHODS： 125 cases of abdominal hysterectomy received spinal combined with epidural anesthesia and then were randomly divided into control group （group C）, preemptive analgesia group Ⅰ （group P1）, preemptive analgesia group Ⅱ （group P2）, preemptive analgesia group Ⅲ （group P3）, postoperative analgesia group （group PO）. Group C did not receive analgesic drugs before surgery; group P1 was given intravenous injection of flurbiprofen and epidural injection of fentanyl ＋ketamine before operation; group P2 received intravenous injection of flurbiprofen before operation, and then was given epidural injection of fentanyl＋ketamine after operation; group P3 was given epidural injection of fentanyl＋ketamine before operation, and then received intravenous injection of flurbiprofen after operation; group PO received intravenous injection of flurbiprofen and epidural injection of fentanyl ＋ketamine after operation. The concentrations of cortisol （Cor）, glucose （Glu）, IL-6 and TNF-α were observed in each group before operation, on the 1st day and 2nd day after operation. RESULTS： There was no statistical significance in the concentrations of Cor, Glu, IL-6 and TNF-α before operation （P〉0.05）. The concentrations of Cor, Glu, IL-6 and TNF-α in group P1, P2, P3 and PO were significantly lower than in group C on the 1st day and 2nd day after operation （P〈 0.05） ; the concentrations of Cor, Glu, IL-6 and TNF-α in group P2 and P3 were significantly lower than in group P1 and PO （P〈 0.05）. CONCLUSIONS： Multimodal preemptive can analgesia effectively inhibit stress response and inflammatory in patients with abdominal hysterectomy.

关 键 词：超前镇痛 多模式 腹式全子宫切除术 应激反应 炎性因子 

分 类 号：R971.2[医药卫生—药品] R969.4[医药卫生—药学]