羟考酮超前镇痛对腹部闭合性损伤急诊手术患者神经系统敏感性及炎症反应水平的影响  

Effect of Oxycodone Preemptive Analgesia on Nervous System Sensitivity and Inflammatory Re-sponse Level in Emergency Surgery Patients with Closed Abdominal Injury

作　　者：丁连仁 DING Lianren(Pain Department,People's Hospital of Huimin County,Shandong Binzhou 251700)

机构地区：[1]山东省惠民县人民医院疼痛科,山东滨州251700

出　　处：《医学临床研究》2020年第4期573-575,579,共4页Journal of Clinical Research

摘　　要：[目的]评价羟考酮超前镇痛对腹部闭合性损伤急诊手术患者神经系统敏感性及炎症反应水平的影响.[方法]本院收治的腹部闭合性损伤在急诊全麻下行开腹手术患者136例,随机分为观察组(n=69)和对照组(n=67),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,对照组患者注射等量0.9%氯化钠溶液10 mL.比较两组患者术毕清醒时刻(T1)、术后2 h(T2)、术后6 h(T3)、术后12 h(T4)、术后24 h(T5)等5个时间视觉模拟评分(VAS评分),血清肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)、白细胞介素6(IL-6)、5-羟色胺(5-HT)及P物质水平.[结果]观察组患者在术后12 h内VAS评分均显著低于对照组(均P<0.01).两组TNF-α、IL-1β、IL-6从T1时刻开始升高,TNF-α、IL-1β在T5时刻达到最大值,IL-6值在T3时刻达到最大值,随后逐渐降低,T2~T5时刻两组TNF-α、IL-1β、IL-6与同组T0时间点比较差异均有显著差异(均P<0.05),但与对照组比较,各时间点观察组患者血清炎性因子水平均明显降低(P<0.05).术毕至术后24 h,两组血清P物质及5-HT水平逐渐升高,与对照组比较,观察组患者T1~T5时刻血清P物质及5-HT水平均明显降低(均P<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,从而有效减轻术后疼痛.[Objeetive]To evaluate the efet of preemptive analgesia with oxycodone on neurological sensitivity and inflammatory response in patients with closed abdominal injury.[Methods]A total of 136 patients with abdomninal closed injury underwent emergency anesthesia for open surgery.The patients were randomly divided into the observation group(n=69)and the control group(n=67).The observation group received intravenous injection of oxycodone 0.1 mg/kg at 10 min before anesthesia induction,while the control group received an equal volume of 0.9%sodium chloride solution.Visual analogue scales(VAS scores)and levels of serum tumor necrosis factor alpha(TNF-α),interleukin 1β(IL-1β),.interleukin 6(IL-6),serotonin(5-HT)and substance P were compared at the time of awakening(T1)and 2h(T2),6h(T3),12h(T4),24h(T5)after surgery between the two.[Results]The VAS scores of the observation group at time points within 12 hours after operation were significantly lower than those of the control group(all P<0.01).The levels of TNF-α,IL-1βand IL-6 increased from T.then TNF-αand IL-1βreached the maximum at T5,and IL-6 reached the maximum at T3,thereafter they gradually decreased.At the time period of T2-T5,the levels of TNF-α,IL-1βand IL-6 in the two groups were significantly different from levels of T0 in the same group(P<0.05).Compared to the control group,levels of serum inflammatory factors at each time point in the observation group were reduced(P<0.05).Serum substance P and 5-HT levels of the two groups increased gradually from 24 hours after surgery.Compared to the control group,levels of serum P and 5-HT at the time of T1-T5 in the observation group were significantly lower(all P<0.05).[Conclusion]Preemptive analgesia with oxycodone inhibits the release of inflammatory factors and reduces the sensitivity of central and peripheral nervous system in patients with emergency surgery of closed abdominal injury.Thus it effectively reduces postoperative pain.

关 键 词：腹部/损伤 腹部损伤/外科学 羟可酮/药理学 镇痛 

分 类 号：R656[医药卫生—外科学]