两种镇痛策略对胃癌患者腹腔镜辅助胃切除术后中性粒细胞与淋巴细胞比值的影响  

Influence of two analgesic regimens on neutrophi-lymphocyte ratio after laparoscope assisted gastrectomy for patients with gastric cancer

作　　者：纪玉玮 魏磊[1] 沈濛溦 苏惠斌[1] 王卉 JI Yu-wei(Suzhou municipal hospital&Suzhou hospital affiliated to Nanjing Medical University,Suzhou,Jiangsu,215002,China)

机构地区：[1]苏州市立医院/南京医科大学附属苏州医院,江苏苏州215002

出　　处：《齐齐哈尔医学院学报》2020年第22期2786-2788,共3页Journal of Qiqihar Medical University

基　　金：南京医科大学科技发展基金(NMUB2018211)。

摘　　要：目的比较两种术后镇痛方案对腹腔镜胃癌根治术后镇痛效果和中性粒细胞与淋巴细胞比值(NLR)的影响.方法选择2018年1月—2020年6月在本院择期行腹腔镜胃癌根治术患者40例作为研究对象,采用随机数表法分为IT组和IA组,每组各20例.IT组患者术前鞘内注射200 ug吗啡,术毕应用氟比洛芬进行静脉自控镇痛(PCIA);IA组患者术毕应用吗啡+氟比洛芬PCIA.分别观察两组患者术后6 h、24 h静息和活动状态下数字疼痛评分(NRS)、肠通气时间、不良反应情况及NLR.结果IT组患者术后6 h的NRS评分较低,且术后24 h活动状态下NRS评分低于IA组,差异有统计学意义(P<0.05);IT组患者肠功能恢复较快,差异有统计学意义(P<0.05);术前两组患者NLR无统计学差异,术后IT组患者NLR低于IA组,差异有统计学意义(P<0.05);两组患者瘙痒、恶心呕吐发生率无统计学差异(P>0.05).结论鞘内小剂量吗啡联合氟比洛芬PCIA镇痛可为腹腔镜辅助胃癌根治术患者提供良好的术后镇痛,并降低术后NLR水平.Objective To compare the influence of two postoperative analgesia methods on the analgesic effect and the neutrophil-lymphocyte ratio(NLR) for patients received laparoscope assistedgastric cancer surgery.Methods Forty patients undergoing elective laparoscope-assisted gastrectomy were enrolled in the study and randomly divided into IT and IA group using a random number table method, 20 patients in each group. Participants in IT group received 200μg morphine intrathecally before surgery and patient-controlled intravenous analgesia with flurbiprofen after surgery. Patients in IA group received patient-controlled intravenous analgesia with a combination of flurbiprofen and morphine after surgery. Pain scores at rest state and on movement at 6 and 24 hours after surgery, intestinal ventilation time, the incidence of side effectsand neutrophil-lymphocyte ratio were observed and recorded.Results The NRSscorein IT group wasrelatively lowat 6 h after surgery, and NRS score in IT group was lower than that in the IA group, with statistically significant difference(P<0.05). The intestinal function of IT group recovered quickly, the difference was statistically significant(P<0.05). Pre-operative neutrophil lymphocyte ratio was similar between the two groups, while postoperative neutrophil lymphocyte ratio was lower in IT group(P<0.05).There were no significant differences in the incidence of pruritis, nausea and vomiting between the two groups(P>0.05).Conclusions Intrathecal low-dose morphine combined with flurbiprofen PCIA analgesia could provide excellent postoperative analgesia for patients undergoing laparoscopic radical gastric cancer surgery and reduce postoperative NLR levels.

关 键 词：术后镇痛 鞘内吗啡 中性粒细胞与淋巴细胞比值 肠通气时间 不良反应 胃癌根治术 

分 类 号：R614[医药卫生—麻醉学]