疼痛治疗中糖皮质激素对外周血白细胞、血糖和血压的影响  

Effect of corticosteroids on peripheral blood leucocyte,blood glucose and blood pressure in the treatment for pain

作　　者：翁梅琳 杜冬萍[3] 徐永明[3] 缪长虹 

机构地区：[1]复旦大学附属肿瘤医院麻醉科 [2]复旦大学上海医学院肿瘤学系,上海200032 [3]上海交通大学附属第六人民医院疼痛科,上海200233

出　　处：《复旦学报（医学版）》2014年第4期516-521,共6页Fudan University Journal of Medical Sciences

摘　　要：目的研究糖皮质激素治疗疼痛性疾病时对外周血白细胞、血糖和血压的影响,并观察其疗效及不良反应。方法选择44例明确诊断为疼痛性疾病的患者,根据实际治疗需要将患者分成两组:得宝松组(D组,n=22)使用0.1%得宝松+0.1%布比卡因,曲安奈德组(T组,n=22)使用0.04%的曲安奈德+0.1%布比卡因。分别测定治疗前、治疗后第1、4、7天的血常规、空腹血糖、血压的变化情况,同时采用疼痛视觉模拟评分(visual analogue scale,VAS)评估各时间点的疼痛程度,并记录其不良反应。结果与治疗前相比,两组患者治疗后第1、4天白细胞计数、中性粒细胞计数均显著升高(P<0.01);治疗后第1天,与T组相比,D组对外周血白细胞、中性粒细胞的影响更显著(P<0.01);外周血白细胞、中性粒细胞计数的升高与糖皮质激素的用量呈显著性相关(P<0.01)。与治疗前相比,两组患者治疗后第1、4天淋巴细胞、嗜酸性粒细胞、嗜碱性粒细胞计数均显著降低(P<0.01),治疗后第7天嗜酸性粒细胞计数仍降低(P<0.05)。与治疗前相比,D组治疗后第1天空腹血糖显著升高(P<0.01));治疗后第1天,与T组相比,D组对空腹血糖的影响更显著(P<0.01)。空腹血糖的升高与糖皮质激素的用量呈显著性相关(P<0.01)。两组患者的血压在治疗前后的差异均无统计学意义(P>0.05)与治疗前相比,两组治疗后第1、4、7天的VAS显著降低(P<0.01)。与T组相比,D组对疼痛缓解的有效率更高(P<0.05)。D组的不良反应发生率明显高于T组,所有不良反应均为轻度。结论糖皮质激素能有效缓解疼痛,仅引起轻度不良反应。Objective In the present study we tried to investigate the effects of corticosteroids on peripheral blood leucocytes,blood glucose and blood pressure,meanwhile to observe the therapeutic effects and side effects of corticosteroids administration.Methods Forty-four patients with pain were divided into two groups according to therapy：diprospan group （D group,n=22） treated with 0.1 % diprospan ＋ 0.1 % bupivacaine,and triamcinolone group （T group,n =22） treated with 0.04% triamcinolone ＋ 0.1% bupivacaine.Routine blood examination,fasting plasma glucose,blood pressure,visual analogue scale （VAS） and side effects at pre-therapy and on the 1st,4th,and 7th day after the therapy were observed.Results The count of leucocytes and neutrophils increased significantly on the first and fourth day after the therapy （P〈0.01）.The drug effect on leucocytes and neutrophils was greater in D group than in T group on the first day after therapy （P 〈 0.01）.The elevation of leucocytes and neutrophils was significantly correlated with the dosage of corticosteroids （P〈0.01）.The count of lymphocytes,eosinophilic granulocytes,basophilic granulocytes decreased significantly on the 1st and 4th day after the therapy （P〈0.01）.The count of eosinophilic granulocytes still decreased on the 7th day after the therapy （P〈0.05）.The fasting plasma glucose increased significantly on the 1st day after the therapy in D group （P〈0.01）.The drug effect on fasting plasma glucose was greater in D group than in T group on the 1st day after the therapy （P〈0.01）.The elevation of fasting plasma glucose was significantly correlated with the dosage of corticosteroids （P〈0.01）.Blood pressure showed no significant change in both groups after the therapy （P〈0.05）.The score of VAS decreased significantly on the 1st,4th and 7th day after the therapy （P〈0.01）.The pain relieve rate was higher in D group than that in T group （P〈0.05）.The incidence of side effects was higher in D group than in

关 键 词：糖皮质激素 白细胞 中性粒细胞 血糖 血压 疼痛治疗 神经阻滞 

分 类 号：R614.4[医药卫生—麻醉学] R441.1[医药卫生—外科学]