多模式镇痛方案对妇科腹腔镜手术患者的镇痛效果及血流动力学变化、炎性因子的影响  

Effects of Multimode Analgesic Protocol on Analgesia,Hemodynamic and Inflammatory Factors in Patients with Gynecological Laparoscopy

作　　者：罗海鸣 金善良[1] 全宗宗 LUO Hai-ming;JIN Shan-liang;QUAN Zong-zong(Shanghai Jiaotong University School of Medicine,201900)

机构地区：[1]上海交通大学医学院附属第九人民医院麻醉科,上海201900

出　　处：《医学临床研究》2020年第7期968-970,975,共4页Journal of Clinical Research

基　　金：上海市科委基金项目(20113140)。

摘　　要：【目的】探讨多模式镇痛方案对妇科腹腔镜手术患者的镇痛效果及血流动力学、炎性因子的变化影响。【方法】在本院接受妇科腹腔镜手术的患者136例,随机分为两组。对照组给予传统单一镇痛药物的镇痛方案,观察组给予多模式镇痛方案,比较两组麻醉镇痛效果。【结果】观察组芬太尼用量少于对照组(P<0.05),阿片类药物用量和术后住院天数与对照组比较差异无显著性(P>0.05)。两组入室(T0)、麻醉诱导后5 min(T1)时平均动脉压(MAP)、心率(HR)水平组间比较差异无显著性(P>0.05)。观察组手术开始即刻(T2)、手术结束即刻(T3)、拔管即刻(T4)时MAP、HR水平低于对照组(P<0.05)。两组术前肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平组间比较差异无显著性(P>0.05)。观察组手术开始30 min、术后2 h、术后24 h时TNF-α、IL-6水平低于对照组(P<0.05)。两组拔管后10 min时VAS评分组间比较差异无显著性(P>0.05)。观察组术后6 h、术后12 h、术后24 h时VAS评分均低于对照组(P<0.05)。【结论】多模式镇痛方案用于妇科腹腔镜手术可稳定术中MAP、HR水平,抑制炎症因子的表达,减轻患者疼痛程度。【Objective】To investigate the effect of multi-mode analgesia on analgesia,hemodynamics and inflammatory factors in patients undergoing gynecological laparoscopic surgery.【Methods】A total of 136 patients who underwent gynecological laparoscopic surgery in our hospital were selected and divided into two groups by random.The control group was given the traditional single analgesic regimen,while the observation group was given the multi-mode analgesic regimen.The analgesic effect,hemodynamics and inflammatory factors between the two groups were compared.【Results】The dosage of fentanyl in the observation group was lower than that in the control group(P>0.05).However,no significant differences were shown in the dosage of opioid drugs and the days of hospitalization after operation between the two groups(P>0.05).The heart rate(HR)and level of mean arterial pressure(MAP)between the two groups before induction(T0)and at 5min(T1)after anesthesia induction did not show significant difference(P>0.05).The levels of MAP and HR in the observation group were lower than those in the control group(P<005)immediately after operation(T2),at the end of operation(T3)and immediately after extubation(T4).There were no statistically significant differences in the levels of TNF-αand IL-6 between the two groups before surgery(P>0.05).While the levels of TNF-αand IL-6 in the observation group were lower than those in the control group at 30 minutes,2 hours and 24 hours after operation(P<005).There was no significant difference in VAS scores between the two groups at 10 min after extubation(P>005).The scores of VAS in the observation group were lower than those in the control group at 6 h,12 h and 24 h after operation(P<0.05).【Conclusion】The application of multi-mode analgesia in gynecological laparoscopic surgery can stabilize the level of MAP and HR,inhibit the expression of inflammatory factors,and alleviate the pain degree of patients.

关 键 词：妇科外科手术 腹腔镜检查 镇痛 血流动力学 

分 类 号：R713[医药卫生—妇产科学]