羟考酮超前镇痛对腹部闭合性损伤患者术后镇痛效果及炎性因子的影响  

Effects of Preemptive Analgesia with Oxycodone on Postoperative Analgesia and the Level of Inflammatory Cytokines in Patients with Closed Abdominal Trauma

作　　者：张金立[1] 肖芳 白艳辉[1] 代志强 于红莲[3] 王硕[4] ZHANG Jin-li;XIAO Fang;BAI Yan-hui;DAI Zhi-qiang;YU Hong-lian;WANG Shuo(Department of Anesthesiology,the First Central Hospital of Baoding,Baoding,Hebei 071051,China;Department of Anesthesiology,Baoding Maternal and Child Health Hospital,Baoding,Hebei 071051,China;Department of Surgery,Baoding Second Hospital,Baoding,Hebei 071051,China;Department of Surgery,Affiliated Hospital of Hebei University,Baoding,Hebei 071000,China)

机构地区：[1]保定市第一中心医院麻醉科,河北保定071051 [2]保定市妇幼保健院麻醉科,河北保定071051 [3]保定市第二医院外科,河北保定071051 [4]河北大学附属医院外科,河北保定071000

出　　处：《临床误诊误治》2018年第7期37-41,共5页Clinical Misdiagnosis & Mistherapy

基　　金：保定市科学技术局科学技术研究与发展计划(17ZF258);保定市卫生局基金项目(201703164)

摘　　要：目的观察羟考酮超前镇痛对腹部闭合性损伤急诊手术患者术后镇痛效果,以及对炎性因子的影响。方法选取2017年1—12月保定市第一中心医院收治的腹部闭合性损伤在急诊全麻下行开腹手术患者60例,采用随机数字表法分为观察组和对照组各30例。观察组于麻醉诱导前10 min静脉注射羟考酮注射液0.1 mg/kg,对照组患者于麻醉诱导前10 min静脉注射0.9%氯化钠溶液10 ml。观察两组患者术毕苏醒即刻及术后2、6、12、24 h视觉模拟评分(VAS);于两组应用羟考酮或0.9%氯化钠溶液前10 min(T1)、术毕即刻(T2)、术后6 h(T3)、术后12 h(T4)、术后24 h(T5)5个时点抽取患者静脉血,采用酶联免疫吸附法检测血清白细胞介素(IL)-6、IL-10、肿瘤坏死因子-α(TNF-α)水平。结果观察组患者在术毕苏醒即刻、术后2 h、术后6 h、术后12 h VAS评分均显著低于对照组,差异有统计学意义(P<0.01)。T3、T4、T5时,两组IL-6水平均较T1和T2时显著升高(P<0.05),且观察组IL-6水平显著低于对照组(P均<0.01);T3、T4时,两组IL-10水平显著升高(P<0.05),且观察组IL-10水平显著高于对照组(P均<0.01);T4、T5时,两组血清TNF-α水平较T1时显著升高(P<0.05),且观察组血清TNF-α水平显著低于对照组(P均<0.05)。结论羟考酮超前镇痛能抑制腹部闭合性损伤急诊手术患者术后机体炎性因子的释放,降低中枢及周围神经系统敏感性,从而达到减轻术后疼痛、促进康复的目的。Objective To observe the effect of preemptive analgesia with oxycodone on postoperative analgesia and levels of inflammatory cytokines in patients undergoing emergency laparotomy due to closed abdominal trauma.Methods A total of 60 cases who underwent emergency laparotomy under general anesthesia after admission to The First Central Hospital of Baoding were randomly divided into observation group and control group,with 30 cases in each group,according to the random number table.Patients in observation group were injected intravenously with 0.1 mg/kg oxycodone 10 min before induction of anesthesia,and those in control group were given 10 ml 0.9%saline in the meantime.VAS was recorded at different time points,including awaking time immediately after surgery,as well as at 2,6,12,and 24 h after surgery.The levels of interleukin-6(IL-6),interleukin 10(IL-10)and tumor necrosis factor-α(TNF-α)were measured by ELISA in 10 min before intravenous injection of oxycodone or 0.9%saline(TI),immediately after surgery(T2),6 h(T3),12 h(T4),and 24 h(T5)after surgery.Results VAS was significantly lower in observation group immediately after surgery,and at 2,6 and 12 h after surgery,and there were significant differences(P<0.01).Serum levels of IL-6 at three time points(T3,T4 and T5)after surgery were significantly higher than those at T1 and T2(P<0.05),and serum levels of IL-6 in observation group were significantly lower than those in control group(both P<0.01).IL-10 level at T3 and T4 was significantly higher in both groups(P<0.05),and serum IL-10 in observation group was significantly higher than control group(both P<0.01).Serum TNF-αconcentration at T4 and T5 was significantly higher in both groups than that at T1(P<0.05).In addition,the level of TNF-αin observation group was significantly lower than that in control group at T4 and T5(both P<0.05).Conclusion In patients receiving emergency laparotomy due to closed abdominal trauma,preemptive analgesia with oxycodone can inhibit the release of inflammatory factors,and reduce

关 键 词：腹部损伤 羟考酮 麻醉和镇痛 炎性因子 

分 类 号：R614[医药卫生—麻醉学]