摘要
目的研究硬膜外自控镇痛(PCEA)和静脉自控镇痛(PCIA)对上腹部术后炎性反应的抑制作用。方法上腹部手术患者60例,随机分为两组,每组30例。均选择全麻气管插管加硬膜外麻醉,手术结束时行自控镇痛(PCA)。E组行罗哌卡因复合芬太尼PCEA,I组行芬太尼复合氯诺昔康PCIA。负荷剂量3～5 ml+背景剂量2～2.5 ml/h,PCA剂量每次1 ml,锁定时间15 min。采用双抗体夹心ELISA法和免疫透射比浊法检测术后0、6、244、8 h血清白细胞介素(IL)-6I、L-10和C-反应蛋白(CRP)浓度。行VAS疼痛评分。结果术后6 h,E组和I组IL-6I、L-10均显著升高(P<0.05);术后24 h,E组IL-6显著降低,IL-10仍升高,I组IL-6I、L-10均较高(P<0.05),E组和I组CRP均明显升高(P<0.05)。术后6 h,E组IL-6、CRP显著低于I组,IL-10显著高于I组(P<0.05);术后48 h,E组IL-6I、L-10均显著低于I组(P<0.05)。结论不同镇痛方式对上腹部术后过度炎性反应均有抑制作用,但PCEA优于PCIA。
Objective To investigate the suppressive effect of different postoperative analgesic ways on inflammatory response to upper abdominal operation. Methods Sixty patients underwent upper abdominal surgery under general anesthesia were randomly divided into two groups with 30 cases each. At the end of surgery, patient-controlled epidural analgesia（PCEA） with ropivacaine and fentanyl was used in group E and patient controlled intravenous analgesia （PCIA） with fentanyl lornoxicam in group I. Analgesia was set up with a loading dose of 3-5 ml＋baekground dose of 2-2.5 ml/h,PCA dose of 1 ml, lockout time 15 rain. Serum interleukin（IL） 6 and IL-10 were detected by double-antibody sandwich EI.ISA and CRP was measured by immunoturbidimetry at 0,6,24 and 48 h. The VAS scoring was carried out as well. Results Compared to 0 h, IL-6 and IL-10 in two groups were increased significantly at 6 h after operation（P〈0. 05） and IL-6 in group E was decreased significantly, IL-6 and IL-10 in group I were all increased （P〈0.05）. CRP in groups of E and 1 were increased at 24 h after operation（ P〈0. 05 ）. IL-6 and CRP were higher and IL-10 was lower in group I than those in group E at 6 h after operation（P〈0.05）. IL-6 and IL-10 were lower in group E than those in group I at 48 h after operation（P〈（0. 05）. Conclusion The suppressive effect of PCEA on inflammatory response to upper abdominal operation is more than that of PCIA.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2010年第4期301-303,共3页
Journal of Clinical Anesthesiology
基金
新疆石河子市科研课题资助项目(项目编号:2007YL02)
