舒芬太尼联合氯胺酮术后静脉镇痛效果及其对血清白细胞介素-6和白细胞介素-10的影响  

Effect of postoperative intravenous analgesia with Sufentanil combined with Ketamine on serum IL-6 and IL-10

作　　者：鲁应军[1] 陈章玲[1] 朱涛[1] 纪健[1] 肖瑛[1] 李强[1] 冯成[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：《中国现代医学杂志》2015年第24期23-27,共5页China Journal of Modern Medicine

摘　　要：目的 观察舒芬太尼联合氯胺酮术后自控静脉镇痛的效果及其对血清IL-6和IL-10的影响。方法择期行上腹部手术的60例患者,随机分为S组、SK组和C组,每组20例。各组均行自控静脉镇痛,负荷量5 ml,背景剂量2 ml/h,PCA 2 ml/次,锁定时间30 min。S组镇痛配方：舒芬太尼2.5μg/kg用0.9%氯化钠溶液稀释至100 ml;SK组镇痛配方：舒芬太尼2μg/kg,氯胺酮2 mg/kg用0.9%氯化钠溶液稀释至100 ml;C组为对照组,镇痛配方：吗啡1.2 mg/kg用0.9%氯化钠溶液稀释至100 ml。分别在术后1、2、4、8、16、24、36、48 h记录患者VAS疼痛评分及不良反应,于麻醉前、术后2、8、24、48 h 5个时间点抽取外周静脉血行血清IL-6、IL-10浓度测定。结果 SK组和S组镇痛效果明显优于C组,且SK组优于S组。不良反应发生率SK组与S组差异无统计学意义（P〉0.05）,明显低于C组（P〈0.05）。3组患者IL-6和IL-10在术后2-48 h均有明显升高,C组IL-6和IL-10在术后2、8、24 h逐渐升高,IL-6在术后24 h达到峰值,IL-10在术后8 h达到峰值,且在术后各时点明显高于SK组和S组（P〈0.01）。在术后2 h,SK组和S组的IL-6和IL-10水平差异无统计学意义（P〉0.05）,但术后8、24、48 h,SK组的IL-6、IL-10水平均低于S组（P〈0.05）。结论 舒芬太尼联合氯胺酮应用于患者自控静脉镇痛,效果确切,能有效抑制患者术后48 h内IL-6、IL-10水平的升高,具有良好的免疫保护和控制应激反应的作用。【Objective】 To observe the effect of patient-controlled intravenous analgesia with Sufentanil combined with Ketamine after operation and its influence on serum IL-6 and IL-10. 【Methods】 Totally 60 patients undergoing upper abdominal operation were randomly divided into three groups（20 in each group）.After operation the patient-controlled intravenous analgesia, with a load of 5 ml, a background dose of 2 ml/h,2 ml for each blous and 30 min locking time, was given to every patient. For the group S the analgesic prescription was Sufentanil 2.5 μg/kg diluted to 100 ml with 0.9% sodium chloride solution. For the group SK the analgesic prescription was Sufentanil 2.0 μg/kg and Ketamine 2 mg/kg diluted to 100 ml with 0.9% sodium chloride solution. For the group C the analgesic prescription was Morphine 1.2 mg/kg diluted to 100 ml with0.9% sodium chloride solution. The pain scores and the adverse reactions were recorded at 1, 2, 4, 8, 16,24, 36 and 48 h postoperatively. Venous blood samples were taken before anesthesia, 2, 8, 24 and 48 h after operation for determination of serum concentrations of IL-6 and IL-10 by ELISA.【Results】 The analgesic effect of the groups SK and S was significantly higher than that of the group C, and higer in the group SK than in the group S. The incidence of adverse reactions in the group SK and the group S had no statistical difference（P〈0.05）, but was significantly lower than that in the group C（P〈0.05）. The IL-6 and IL-10 significantly increased in the 3 groups 2 -48 h after operation. In the group C, IL-6 and IL-10 gradually increased at 2, 8 and 24 h after operation; the peak time of IL-6 and IL-10 was at 24 h and 8 h after operation respectively. The concentrations of IL-6 and IL-10 in the group C were significantly higher than those in the groups SK and S at each postoperative time point（P〈0.01）. There were no significant differences in the IL-6 and IL-10 levels between the group SK and the group S 2 h after operation（P〈0.05）. But the IL-6and I

关 键 词：舒芬太尼 氯胺酮 术后患者自控静脉镇痛 炎症介质 

分 类 号：R614.1[医药卫生—麻醉学]