氢吗啡酮联合地佐辛麻醉对胸膜炎患者术后镇痛效果及对炎症因子水平的影响  

Effect of hydromorphone combined with dezocine on postoperative pain and inflammatory factors in tuberculous empyema patients

作　　者：杨志军[1] 黄佳洋[1] 熊浪 刘会长[1] YANG Zhijun;HUANG Jiayang;XIONG Lang;LIU Huizhang(Department of Anesthesiology, Ezhou Central Hospital, Ezhou Hubei 436000, China)

机构地区：[1]鄂州市中心医院麻醉科

出　　处：《空军医学杂志》2019年第3期246-249,共4页Medical Journal of Air Force

摘　　要：目的探讨氢吗啡酮联合地佐辛麻醉对胸膜炎患者术后镇痛效果及对炎症因子水平的影响。方法将106例结核性脓胸患者随机分作对照组与观察组,对照组进行氢吗啡酮麻醉,观察组进行氢吗啡酮联合地佐辛麻醉,全麻后2组患者均行胸膜纤维板脱落术,采用酶联免疫吸附法(enzyme linked immunosorbent assay,ELISA)检测与比较2组患者术前与术后疼痛介质含量与炎症因子水平。结果术后24、48h,2组疼痛介质P物质(substance P,SP)、缓激肽(bradykinin,BK)、组织胺(histamine,HIS)含量均明显高于术前,且观察组疼痛介质SP、BK、HIS含量明显低于对照组;术后12、24h,2组肿瘤坏死因子α(tumor necrosis factor α,TNF-α)、干扰素γ(interferon γ,IFN-γ)均升高;且观察组的TNF-α、IFN-γ水平显著低于对照组(P<0.05);术后2、4周,2组用力肺活量(forced vital capacity,FVC)与第1s用力呼气量(forced expiratory volume in the first second,FEV1)均增加(P<0.05),胸膜厚度均低于治疗前(P<0.05);且观察组FVC与FEV1均明显高于对照组,胸膜厚度低于对照组;观察组心动过缓、恶心呕吐、嗜睡等不良反应发生率显著低于对照组,组间差异均具统计学意义。结论采用氢吗啡酮联合地佐辛麻醉可有效缓解结核性胸膜炎患者术后疼痛,并降低炎症反应,对疾病恢复有利。Objective To investigate the effect of hydromorphone combined with dezocine on pain and inflammatory factors in patients with tuberculous empyema after surgery. Methods One hundred and six cases of tuberculous empyema patients were randomly divided into the control group and observation group. The control group was anesthetized with hydromorphone while the observation group with hydromorphone combined with dezocine. Both groups were given pleural decortication. The contents of pain mediators and inflammatory factors in serum were detected by Elisa before and after surgery, and were compared between the two groups. Results 24 hours and 48 hours after surgery, the contents of pain mediators SP, BK and HIS were significantly higher in both groups, but they were significantly lower in the observation group than in the control group. 24 hours and 48 hours after surgery, the levels of TNF-α and IFN-γ were significantly higher in both groups, but were significantly lower in the observation group than in the control group(P<0.05). 2 weeks and 4 weeks after surgery, FVC and FEV1 in the two groups were significantly higher,espeically in the observation group. Pleural thickness in the two groups was significantly reduced after surgery(P<0.05), especially in the observation group. The incidence of adverse reactions(bradycardia, nausea and vomiting, and sleepiness)was significantly lower in the observation group than in the control group. The difference between the two groups was statistically significant. Conclusion Hydromorphone combined with dezocine can effectively relieve the pain in tuberculous empyema patients after surgery, reduce inflammatory reactions, and is conducive to recovery.

关 键 词：氢吗啡酮 地佐辛 结核性脓胸 结核性胸膜炎 

分 类 号：R561.1[医药卫生—呼吸系统]