酮咯酸氨丁三醇联合地佐辛用于结直肠癌术后患者自控静脉镇痛的作用及对疼痛因子的影响  

Effect of Ketorolac Tromethamine Combined with Dezocine for Patient-controlled Intravenous Analgesia after Colorectal Cancer Surgery and Its Influence on Pain Factors

作　　者：王晓飞[1] 王先锋[1] 陈海涛[1] 王学东 WANG Xiaofei;WANG Xianfeng;CHEN Haitao;WANG Xuedong(Department of Anesthesiology,General Hospital of Anhui Wanbei Coal and Power Group/the Third Affiliated Hospital of Bengbu Medical College,Suzhou 234000,China;Department of Clinical Laboratory,the Second People′s Hospital of Anhui Province,Hefei 230041,China)

机构地区：[1]皖北煤电集团总医院,蚌埠医学院第三附属医院麻醉科,安徽宿州234000 [2]安徽省第二人民医院检验科,合肥230041

出　　处：《医学综述》2022年第15期3073-3078,共6页Medical Recapitulate

基　　金：国家自然科学基金(81972834)。

摘　　要：目的研究酮咯酸氨丁三醇联合地佐辛用于结直肠癌(CRC)术后患者自控静脉镇痛(PCIA)的作用及对疼痛因子的影响。方法选取2018年3月至2021年3月在皖北煤电集团总医院行CRC根治术的74例患者为研究对象,按术后镇痛方法不同分为对照组(地佐辛0.8 mg/kg)和联合组[酮洛酸氨丁三醇(1.5 mg/kg)+地佐辛(0.4 mg/kg)],每组37例,两组术后均采用PCIA方式镇痛。比较两组术后1、6、12、24、48 h疼痛视觉模拟评分法(VAS)评分、伯格曼舒适度评分(BCS)、Ramsay镇静评分,比较两组术后48 h内镇痛泵按压次数、镇痛泵药物消耗量,麻醉前和术后1、12、24、48 h血清5-羟色胺(5-HT)、P物质水平以及两组术后48 h内不良反应发生情况。结果术后各时点间VAS、BCS、Ramsay镇静评分的主效应差异有统计学意义(P<0.01);两组间VAS、Ramsay镇静评分的主效应差异有统计学意义(P<0.01),BCS评分主效应差异无统计学意义(P>0.05);VAS评分的时点间与组间存在交互作用(P<0.01),而BCS、Ramsay镇静评分的时点间与组间不存在交互作用(P>0.05)。两组术后1、6、12、24、48 h的VAS、Ramsay镇静评分逐渐降低,而BCS评分逐渐升高(P<0.05);且联合组术后1、6、12、24、48 h的VAS、Ramsay镇静评分均明显低于对照组(P<0.05)。联合组患者48 h内镇痛泵按压次数、镇痛泵药物消耗量均少于对照组[(11.02±4.41)次比(13.25±4.39)次、(70±6)ml比(76±8)ml](P<0.05)。血清5-HT、P物质水平组间、时点间的主效应差异有统计学意义(P<0.01),时点间与组间存在交互作用(P<0.01);两组术后1、12、24、48 h血清5-HT、P物质水平逐渐降低,且联合组均低于对照组(P<0.05)。两组术后48 h均未发生呼吸抑制的严重不良反应,两组术后48 h总不良反应发生率比较差异无统计学意义(P>0.05)。结论酮咯酸氨丁三醇联合地佐辛用于CRC术后PCIA较单独应用地佐辛的镇痛、镇静效果更好,并能降低镇痛药物用量及术�Objective To study the effect of ketorolac tromethamine combined with dezocine on postoperative patient-controlled intravenous analgesia(PCIA)and its effect on pain factors of colorectal cancer(CRC).Methods A total of 74 patients undergoing CRC surgery who were anesthetized in the General Hospital of Wanbei Coal Power Group from Mar.2018 to Mar.2021 were included.According to different postoperative analgesia methods,they were divided into a control group(dizocine,0.8 mg/kg)and a combined group[ketoprotein tromethamine(1.5 mg/kg)+dizocine(0.4 mg/kg)].PCIA was used for postoperative analgesia in both groups.The visual analogue scale(VAS),Brug-grmann comfort scale(BCS)and Ramsay sedation score were compared between the two groups at 1,6,12,24 and 48 h after operation.The frequency of pressing the analgesic pump within 48 h after operation,the drug consumption of the analgesic pump,the levels of serum 5-hydroxytryptamine(5-HT)and substance P before anesthesia and at 1,12,24 and 48 h after operation,as well as the adverse reactions within 48 h after operation were compared between the two groups.Results The main effect difference of VAS,BCS and Ramsay sedation scores at each time point after operation was statistically significant(P<0.01);there was significant difference in the main effect of VAS and Ramsay sedation scores between the two groups(P<0.01),but there was no significant difference in the main effect of BCS score(P>0.05);there was interaction between VAS time points and groups(P<0.01),but no interaction between BCS and Ramsay sedation scores and groups(P>0.05).VAS and Ramsay sedation scores decreased gradually at 1,6,12,24 and 48 hours after operation,while BCS score increased gradually(P<0.05);the vas and Ramsay sedation scores of the combined group at 1,6,12,24 and 48 hours after operation were significantly lower than those of the control group(P<0.05).The average number of pressing analgesic pump and drug consumption of analgesic pump in 48 h in the combined group were less than those in the control gr

关 键 词：结直肠癌 酮咯酸氨丁三醇 地佐辛 患者自控静脉镇痛 5-羟色胺 P物质 

分 类 号：R735.35[医药卫生—肿瘤]