氢吗啡酮对结直肠癌根治术后患者早期恢复、术后镇痛及应激反应的影响  

Effects of hydromorphone on early postoperative recovery,postoperative analgesia and stress response in patients undergoing laparoscopic radical resection of colorectal cancer

作　　者：陈冯琳[1] 项海华[1] 林洁 Chen Fenglin;Xiang Haihua;Lin Jie(Department of Anesthesiology,Taizhou Hospital of Zhejiang Province,Taizhou 317000,ZheJiang Province,China)

机构地区：[1]浙江省台州医院麻醉科,317000

出　　处：《中国基层医药》2021年第10期1486-1489,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨氢吗啡酮对腹腔镜结直肠癌根治术患者术后早期恢复、术后镇痛和应激反应影响。方法选择浙江省台州医院于2019年6月至2020年6月行腹腔镜根治术的结直肠癌患者120例,采用随机数字表法分为观察组60例与对照组60例。观察组给予术后氢吗啡酮静脉自控镇痛;对照组给予术后舒芬太尼静脉自控镇痛。比较两组围术期指标变化和术后恢复情况、术后3 h、术后12 h和术后24 h视觉模拟评分法(VAS)评分、术前和术后3 d应激反应包括去甲肾上腺素(NE)、白细胞介素6(IL-6)和皮质醇(COR)变化。结果两组结直肠癌患者手术时间和术中出血量差异均无统计学意义(均P>0.05)。观察组术后肠蠕动恢复时间[(57.83±8.98)h]、下床时间[(43.12±2.34)h]和引流管拔除时间[(121.38±10.29)h]均明显短于对照组[(65.21±7.45)h、(45.46±2.19)h和(150.28±13.42)h](t=4.899、5.656、13.238,均P<0.05);观察组VAS评分:术后12 h[(1.89±0.27)分]、术后24 h[(1.45±0.23)分]均低于对照组[(2.19±0.24)分、(1.84±0.20)分](t=6.433、9.911,均P<0.05);观察组术后3 d血清NE[(185.49±18.29)ng/L]、IL-6[(59.91±6.89)ng/L]和COR[(109.21±15.46)μg/L]均低于对照组[(235.41±16.57)ng/L、(73.24±7.68)ng/L和(128.39±10.32)μg/L](t=15.668、10.008、7.993,均P<0.05)。结论氢吗啡酮对腹腔镜结直肠癌根治术患者效果良好,可促进患者术后早期恢复,术后镇痛效果明显,且对应激反应影响小。Objective To investigate the effects of hydromorphone on early postoperative recovery,postoperative analgesia and stress response in patients undergoing laparoscopic radical resection of colorectal cancer.Methods 120 patients with colorectal cancer who underwent laparoscopic radical resection of colorectal cancer in Taizhou Hospital of Zhejiang Province from June 2019 to June 2020 were included in this study.They were randomly assigned to undergo either postoperative patient-controlled intravenous analgesia with hydromorphone(observation group,n=60)or postoperative patient-controlled intravenous analgesia with sugentanil(control group,n=60).The changes of perioperative indexes,postoperative recovery,Visual Analogue Scale score at 3,12 and 24 hours post-surgery,stress response[norepinephrine,interleukin-6 and cortisol]before and 3 days after surgery were compared between the two groups.Results There were no significant differences in operative time and intraoperative blood loss between the two groups(both P>0.05).The time to intestinal peristalsis,the time to getting out of bed,and the time to drainage tube removal in the observation group were(57.83±8.98)hours,(43.12±2.34)hours,and(121.38±10.29)hours,which were significantly shorter than those in the control group[(65.21±7.45)hours,(45.46±2.19)hours and(150.28±13.42)hours,t=4.899,5.656 and 13.238,all P<0.05].Visual Analogue Scale score in the observation group at 12 and 24 hours after surgery was(1.89±0.27)points and(1.45±0.23)points,respectively,which was significantly lower than that in the control group[(2.19±0.24)points,(1.84±0.20)points,t=6.433,9.911,both P<0.05].At 3 days after surgery,serum levels of norepinephrine,interleukin-6 and cortisol in the observation group were(185.49±18.29)ng/L,(59.91±6.89)ng/L,and(109.21±15.46)μg/L,respectively,which were significantly lower than those in the control group[(235.41±16.57)ng/L,(73.24±7.68)ng/L,(128.39±10.32)μg/L,t=15.668,10.008,7.993,all P<0.05].Conclusion Hydromorphone exhibits a good effect on

关 键 词：结直肠肿瘤 腹腔镜检查 镇痛 去甲肾上腺素 白细胞介素6 氢吗啡酮 舒芬太尼 

分 类 号：R735.34[医药卫生—肿瘤]