地佐辛超前镇痛对髋关节置换术患者白细胞介素-6和白细胞介素-10的影响  

Effect of preemptive analgesia with dezocine on interleukin 6 and interleukin 10 levels in patients undergoing hip replacement

作　　者：鲁应军[1] 陈章玲[1] 朱涛[1] 纪健[1] 

机构地区：[1]上海交通大学附属第一人民医院松江分院麻醉科,上海201600

出　　处：《上海医学》2014年第10期839-842,共4页Shanghai Medical Journal

摘　　要：目的观察地佐辛超前镇痛对髋关节置换术患者血清白细胞介素(IL)-6和IL-10水平的影响,并评价其镇痛效果。方法选择择期行髋关节置换术的患者60例,随机分入超前镇痛组、术后镇痛组和对照组,每组20例。超前镇痛组在麻醉前5min、术后镇痛组在术毕时静脉注射地佐辛注射液5mg,对照组在麻醉前5min静脉注射0.9%氯化钠溶液5mL。3组患者均行蛛网膜下隙阻滞麻醉和术后患者自控静脉镇痛。分别在术后1、2、4、8、16、24、36、48h采用疼痛视觉模拟评分(VAS)评估患者的疼痛程度。分别于麻醉前10min和术后2、8、24、48h5个时间点抽取外周静脉血测定血清IL-6和IL-10水平。结果超前镇痛组在术后8、16、24、36h时的疼痛VAS评分均显著低于术后镇痛组和对照组同时间点(P值均<0.05、0.01)。3组患者在术后2、8、24、48h各时间点的IL-6和IL-10水平均较同组麻醉前显著升高(P值均<0.05),且IL-6在术后24h达到峰值,IL-10在术后8h达到峰值。术后镇痛组和对照组在术后2、8、24、48h各时间点的IL-6和IL-10水平均显著高于超前镇痛组同时间点(P值分别<0.01、0.05);对照组在术后8、24h时间点的IL-6和IL-10水平均显著高于术后镇痛组同时间点(P值均<0.05)。结论在髋关节置换术中使用地佐辛超前镇痛,镇痛效果好,并能有效抑制患者术后IL-6和IL-10水平升高。Objective To investigate the effect of preemptive analgesia with dezocine on the levels of interleukin （IL）-6 and IL-10 in patients undergoing hip replacement, and to evaluate its analgesic effect. Methods Sixty patients scheduled for hip replacement were randomly divided into three groups （n = 20）： preemptive analgesia group, postoperative analgesia group and control group. All patients received subarachnoid space block anesthesia and postoperative patient-controlled venous analgesia. Dezocine （5 mg） was intravenously injected 5 rain before anesthesia and at the end of surgery in the preemptive and postoperative analgesia groups, respectively. Normal saline （5 mL） was injected 5 rain before anesthesia in the control group. Analgesic efficacy wasassessed with visual analog scale （VAS） 1 h, 2 h, 4 h, 8 h, 16 h, 24 h, 36 h and 48 h after surgery. Blood samples were collected from all patients 10 min before anesthesia and 2 h, 8 h, 24 h, and 48 h after surgery for assaying the levels of IL-6 and IL-10. Results The scores of VAS at 8 h, 16 h, 24 h and 36 h after surgery in preemptive analgesia group were significantly lower than those in postoperative analgesia group and control group （ P〈0.05, 0.01 ）. Compared with those before anesthesia, the levels of IL-6 and IL-10 at 2 h, 8 h, 24 h and 48 h postoperatively were significantly increased in all patients （all P〈0.05）. And the levels of IL-6 and IL-10 reached the peak at 24 h and 8 h after surgery, respectively. The levels of IL-6 and 11-10 in the postoperative analgesia group and control group were significantly higher than those in the preemptive analgesia group at 2 h, 8 h, 24 h and 48 h postoperatively （ P〈0.01, 0.05）. The IL-6 and IL-10 levels in the control group were significantly higher thanthose in the postoperative analgesia group at 8 h and 24 h after surgery （all P〈0. 05）. Conclusion Preemptive analgesia with dezocine in patients undergoing hip replacement can decrease the levels of IL-6 and IL-10.

关 键 词：地佐辛 超前镇痛 髋关节置换术 炎性介质 

分 类 号：R614[医药卫生—麻醉学]