摘要
目的 评价四种常见不同镇痛方法对子宫切除术后病人血清细胞因子水平的影响。方法 根据镇痛方法的不同,将48例行子宫切除术病人随机分为四组:罗比卡因复合芬太尼硬膜外镇痛组(Ⅰ组,n=12);芬太尼静脉镇痛组(Ⅱ组,n=12);罗比卡因复合曲马多硬膜外镇痛组(Ⅲ组,n=12);曲马多静脉镇痛组(Ⅳ组,n=12)。观察麻醉前、手术后2、24、48和72 h五个时点病人血清细胞因子白细胞介素 6(IL -6)、白细胞介素 10(IL -10)水平的变化。结果 (1)四种镇痛方法均能提供一定的镇痛效果;(2)四组病人术后血清 IL- 6、IL- 10 水平与麻醉前值比较均升高(P<0 .05),一般在术后24 h达峰值。比较血清IL- 6、IL- 10浓度变化,Ⅰ和Ⅲ组抑制这两种细胞因子释放的能力明显强于Ⅱ和Ⅳ组(P<0. 05),与Ⅰ组比较,Ⅲ组更为明显(P<0. 05)。结论 硬膜外局麻药复合阿片受体激动药镇痛模式可更有效地降低术后炎性应激反应。
Objective To compare the effect of four different analgesic techniques on the levels of serum cytokines after hysterectomy. Methods Forty-eight patients were randomly divided into four groups.GroupⅠreceived 0.2% ropivacaine+fentanyl 2μg/ml+0.008% ondansetron for PCEA,groupⅡ fentanyl 8μg/ml+0.008% ondansetron for PCIA,group Ⅲ 0.2% ropivacaince+tramadol 2mg/ml+0.008% ondansetron for PCEA,and group Ⅳ tramadol 8mg/ml+0.008% ondansetron for PCIA.The PCA model for all groups was loading dose 5ml,bolus of 1ml with lock time 10min and background infusion of 1ml/h.The levels of serum interleukin-6 and interleukin-10 were observed at five time points: before anesthesia,at 2,24,48 and 72h after the end of surgery. Results The levels of serum IL-6 and IL-10 increased significantly after operation ,reached at peak values at 24h (P<0.05),and then gradually declined but still higher than the baseline values.The serum IL-6 and IL-10 were significantly lower at 2 and 24h in groupⅠand Ⅲ than those in group Ⅱ and Ⅳ(P<0.05). Compared with group Ⅰ,the serum IL-10 was significantly lower at 24h in group Ⅲ(P<0.05). Conclusion Epidural analgesia can reduce the level of serum interleukin-6 and interleukin-10 and inflammatory response after hysterectomy more efficient than PCIA.
出处
《临床麻醉学杂志》
CAS
CSCD
2005年第2期86-89,共4页
Journal of Clinical Anesthesiology
基金
江苏省医学重点人才资助项目(编号:RC2002058)
