硬膜外腔单次注射吗啡联合地佐辛静脉自控镇痛对腹腔镜结直肠癌根治术患者围手术期镇痛及免疫因子的影响  

Effect of epidural single injection of morphine combined with intravenous controlled analgesia of dezocine on perioperative analgesia and immune factors in patients undergoing laparoscopic radical resection of colorectal cancer

作　　者：凌晨[1] 魏君[2] 刘幸清[1] 邱磊[2] 胡旭东[1] 文先杰 杜小丽[1] 池鸿熙 梁肖霞[1] LING Chen;WEI Jun;LIU Xingqing;QIU Lei;HU Xudong;WEN Xianjie;DU Xiaoli;CHI Hongxi;LIANG Xiaoxia(Department of Anesthesiology,the Second People’s Hospital of Foshan,Foshan 528000,Guangdong,China;Department of Gastrointestinal Surgery,the Second People’s Hospital of Foshan,Foshan 528000,Guangdong,China)

机构地区：[1]佛山市第二人民医院麻醉科,广东佛山528000 [2]佛山市第二人民医院胃肠外科,广东佛山528000

出　　处：《中国现代医生》2023年第16期95-98,103,共5页China Modern Doctor

基　　金：广东省佛山市科学技术局自筹经费类科技计划项目(1920001001042)。

摘　　要：目的探讨硬膜外腔单次注射吗啡联合地佐辛静脉自控镇痛对腹腔镜结直肠癌根治术患者围手术期镇痛及免疫因子白细胞介素-4(interleukin-4,IL-4)和γ干扰素(interferon-γ,IFN-γ)的影响。方法选取2021年1月至2022年3月于佛山市第二人民医院择期行腹腔镜结直肠癌根治术的患者60例,根据随机数字表法将患者分为吗啡组、地佐辛组和联合组,每组各20例。吗啡组患者术毕前30min硬膜外腔单次注射吗啡1.5mg,术后使用硬膜外自控镇痛(吗啡4mg+罗哌卡因300mg+生理盐水100ml);地佐辛组患者术毕前30min静脉注射地佐辛5mg,术后使用静脉自控镇痛(地佐辛0.5mg/kg+生理盐水100ml);联合组患者术毕前30min硬膜外腔单次注射吗啡1.5mg,静脉注射地佐辛5mg,术后使用静脉自控镇痛(地佐辛0.5mg/kg+生理盐水100ml)。评估三组患者术后6h、12h、24h、48h的疼痛视觉模拟评分法(visual analoguescale,VAS)评分,记录不良反应发生情况,比较麻醉前(T_(0))、术毕(T_(1))、术后1d(T_(2))、术后3d(T_(3))的血清IL-4、IFN-γ水平。结果术后6h、12h、24h,联合组和吗啡组患者的VAS评分均显著低于地佐辛组(P<0.05);三组患者的不良反应发生情况比较,差异均无统计学意义(P>0.05);随着时间的推移,三组患者的血清IL-4呈下降趋势,IFN-γ呈上升趋势。T_(2)、T_(3)时点,联合组患者的血清IL-4水平均显著低于吗啡组和地佐辛组(P<0.05);T_(2)时点,联合组患者的血清IFN-γ水平显著高于地佐辛组(P<0.05),T_(3)时点,联合组患者的血清IFN-γ水平显著高于吗啡组和地佐辛组(P<0.05)。结论硬膜外腔单次注射吗啡联合地佐辛静脉自控镇痛对腹腔镜结直肠癌根治术患者具有良好的术后镇痛效果,并可改善患者术后免疫抑制状态。Objective To investigate the effect of epidural single injection of morphine combined with intravenous controlled analgesia of dezocine on perioperative analgesia and immune factors interleukin-4(IL-4)and interferon-γ(IFN-γ)in patients undergoing laparoscopic radical resection of colorectal cancer.Methods A total of 60 patients who underwent elective laparoscopic radical resection of colorectal cancer in the Second People’s Hospital of Foshan from January 2021 to March 2022 were randomly divided into morphine group,dezocine group and combination group,with 20 cases in each group.Morphine group was given a single injection of 1.5 mg morphine in the epidural space 30 min before completion of surgery,followed by epidural controlled analgesia(morphine 4 mg+ropivacaine 300 mg+normal saline 100 ml).Patients in dezocine group received intravenous injection of 5 mg dezocine 30 min before completion of surgery,followed by intravenous controlled analgesia(dezocine 0.5 mg/kg+normal saline 100 ml).Patients in combination group were given a single injection of 1.5 mg morphine in the epidural space and intravenous injection of 5 mg dezocine 30 min before completion of surgery,and were given intravenous controlled analgesia after surgery(dezocine 0.5 mg/kg+normal saline 100 ml).The visual analogue scale(VAS)score at 6h,12h,24h and 48h after surgery was evaluated in the three groups,the occurrence of adverse reactions was recorded,and the serum IL-4 and IFN-γwere compared before anesthesia(T_(0)),after surgery(T_(1)),1 day after surgery(T_(2)),and 3 day after surgery(T_(3)).Results The VAS scores in combination group and morphine group were significantly lower than those in dezocine group at 6h,12h and 24h after surgery(P<0.05).There was no statistical significance in the occurrence of adverse reactions among the three groups(P>0.05).Over time,serum IL-4 decreased and IFN-γincreased in the three groups.At T_(2) and T_(3) time points,the serum IL-4 level in combination group was significantly lower than that in morphine gro

关 键 词：吗啡 地佐辛 结直肠癌 镇痛 白细胞介素-4 Γ干扰素 

分 类 号：R735.3[医药卫生—肿瘤]