不同术后镇痛方式对食管癌患者术后镇痛效果及细胞因子的影响  

Evaluation of the effects of different postoperative analgesic modalities on postoperative analgesia in patients with esopha⁃geal cancer and their effects on cytokines

作　　者：马玉[1] 刘育贤 李彭依 刘辉 卞清明[1] Ma Yu;Liu Yuxian;Li Pengyi;Liu Hui;Bian Qingming(Department of Anesthesiology,the Affiliated Cancer Hospital of Nanjing Medical University,Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Prevention and Treatment,Nanjing 210009,China;Jiangsu Province Key Laboratory of Anesthesiology,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology,Xuzhou Medical University,Xuzhou 221004,China)

机构地区：[1]南京医科大学附属肿瘤医院,江苏省肿瘤医院,江苏省肿瘤防治研究所麻醉科,南京210009 [2]徐州医科大学江苏省麻醉学重点实验室,江苏省麻醉与镇痛应用技术重点实验室,徐州221004

出　　处：《国际麻醉学与复苏杂志》2024年第9期939-943,共5页International Journal of Anesthesiology and Resuscitation

基　　金：江苏省卫健委科研项目(Z‑201403)。

摘　　要：目的探讨患者自控硬膜外镇痛(PCEA)与患者自控静脉镇痛(PCIA)对食管癌根治术患者术后镇痛效果及细胞因子水平的影响。方法择期行食管癌根治术的患者36例,采用随机数字表法按3∶2分为PCEA组(21例)与PCIA组(15例)。两组其他麻醉相同基础上,PCEA组术后采用罗哌卡因(0.15%)联合芬太尼(2 mg/L)的PCEA方案,PCIA组术后采用芬太尼(12μg/kg)的PCIA方案。记录两组患者一般资料,术后2、4、8、16、24、36、48 h静息及运动数字分级评分法(NRS)评分,术后不良反应发生情况,术前、手术结束、术后24 h、术后48 h血清白细胞介素(IL)-1β、IL-6、IL-10、肿瘤坏死因子(TNF)-α水平。结果两组患者一般资料差异均无统计学意义(均P>0.05)。PCEA组患者术后4、8、16、24、36 h静息及运动NRS评分低于PCIA组(均P<0.05),两组患者术后2、48 h时静息及运动NRS评分差异均无统计学意义(均P>0.05)。两组患者不良反应发生率差异无统计学意义(均P>0.05)。PCEA组患者术后48 h血清IL-6水平低于PCIA组(P<0.05),PCEA组患者术后48 h血清IL-1β、IL-6、IL-10水平均低于术后24 h时(均P<0.05)。两组患者其余指标差异均无统计学意义(均P>0.05)。结论食管癌根治术患者术后采用PCEA较PCIA能提供更好的术后镇痛效果,降低患者术后48 h血清IL-6水平。Objective To explore the effects of patient‑controlled epidural analgesia(PCEA)and patient‑controlled intrave‑nous analgesia(PCIA)on postoperative analgesia and cytokine levels in serum on patients undergoing resection of esophageal carcino‑ma.Methods Thirty‑six patients scheduled for elective resection of esophageal carcinoma were assigned to PECA group(21 cases)or PCIA group(15cases)according to the random number table method in a 3:2 ratio.Based on the same other anesthetics in the two groups,the patients in the PCEA group received combined use of ropivacaine(0.15%)and fentanyl(2 mg/L)for PCEA,while the pa‑tients in the PCIA group used fentanyl(12μg/kg)for PCIA as an analgesic regimen.The general information of patients in both groups,postoperative Numerical Rating Scale(NRS)scores at 2,4,8,16,24,36 h and 48 h for rest and movement,and the occurrence of post‑operative adverse events were recorded.The serum levels of interleukin(IL)‑1β,IL‑6,IL‑10,and tumor necrosis factor‑α(TNF‑α)at preoperative,end of the surgery,24 h and 48 h after the surgery were measured in both groups.Results There were no statistically significant differences in general patient information between the two groups(all P>0.05).The NRS scores at rest and during movement in the PCEA group were lower than those in the PCIA group at 4,8,16,24 h and 36 h after surgery(all P<0.05).However,there was no statistically significant difference in NRS scores at rest and during movement between the two groups at 2 h and 48 h after surgery(all P>0.05).There were no statistically significant differences in the incidence of adverse events between the two groups(all P>0.05).Serum IL‑6 levels in the PCEA group were lower than those in the PCIA group at 48 h postoperatively(P<0.05).In addition,the serum levels of IL‑1β,IL‑6,and IL‑10 in the PCEA group at 48 h after surgery were lower than the levels at 24 h after surgery(all P<0.05).There was no statistically significant difference between the two groups for the remaining i

关 键 词：硬膜外镇痛 患者自控镇痛 食管切除术 细胞因子 

分 类 号：R614[医药卫生—麻醉学] R735.1[医药卫生—外科学]