摘要
目的 研究不同镇痛模式对口腔癌手术患者术后镇痛的影响。方法 选取哈尔滨医科大学附属第一医院2021年10月~2022年12月口腔癌患者78例,按照随机数字表法将其分为A组、B组,每组39例。A组分为A1组(超前镇痛+术后镇痛,n=20)和A2组(术后镇痛,n=19),B组分为B1组(超前镇痛+术后镇痛+局部麻醉,n=22)和B2组(术后镇痛+局部麻醉,n=17)。比较4组患者围术期各时间点的生命体征、疼痛视觉模拟评分(visual analogue scale, VAS),检测血清白细胞(white blood cell, WBC)、葡萄糖(glucose, Glu)、C-反应蛋白(C-reactive protein, CRP)、白介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor, TNF-α)水平。结果 入室(T0)阶段,4组患者心率(heart rate, HR)和平均动脉压(mean arterial pressure, MAP)水平比较,差异无统计学意义(P>0.05)。气管插管即刻(T1)、拔管即刻(T2)、拔管后5 min(T3),4组患者HR和MAP水平均较T0升高(P<0.05);MAP在T2时间,A2>A1、B1组,B2>B1组,P<0.05;HR在T1时间,A2、B2>A1、B1组,在T2时间,A2、B2>A1、B1组,在T3时间点,A2、B2>A1、B1组,P<0.05;术后1 h VAS评分,B1<A1<B2<A2组;术后6 h, B1<A1、B2<A2组;术后24 h, B1<A1、B2<A2,P<0.05;T0时间点WBC、Glu、CRP、IL-6、TNF-α水平比较,差异无统计学意义(P>0.05)。Glu水平在术后1 h, B1<A1、B2<A2组,术后6 h, B1<A1、B2<A2组,术后24 h, B1<A2、B2组,A1<A2组,P<0.05;WBC在术后1 h, A2>B2>A1>B1组,术后6 h, A2、B2>A1>B1组,术后24 h, A2>B2>A1>B1组,P<0.05;CRP、IL-6、TNF-α水平在术后1 h、6 h、24 h, B1<A1<B2<A2组,P<0.05。4组患者恶心呕吐、皮肤瘙痒、尿潴留、呼吸抑制等不良反应发生率,差异无统计学意义(P>0.05)。结论 超前镇痛联合术后镇痛联合局部麻醉这一镇痛方案,能够减轻术后炎症反应,镇痛效果优于其他方案。
Objective To examine the influence of different analgesic modes on postoperative analgesia in patients with oral cancer.Methods A total of 78 patients with oral cancer in The First Affiliated Hospital of Harbin Medical University from October 2021 to December 2022 were selected and divided into two groups(group A and group B)according to random number table method,with 39 cases in each group.Group A was divided into group A1(advanced an⁃algesia+postoperative analgesia,n=20)and group A2(postoperative analgesia,n=19),group B was divided into group B1(advanced analgesia+postoperative analgesia+local anes⁃thesia,n=22)and group B2(postoperative analgesia+local anesthesia,n=17).Vital signs,visual analogue scale(VAS)and serum white blood cell(WBC),glucose(Glu),C⁃re⁃active protein(CRP),interleukin⁃6(IL⁃6)and tumor necrosis factor⁃α(TNF⁃α)levels were compared in the four groups at each time point during perioperative period.Results There was no significant difference in heart rate(HR)and mean arterial pressure(MAP)between 4 groups at the stage of invasion(T0)(P>0.05).Immediately after endotracheal intubation(T1),immediately after extubation(T2),5 minutes after extubation(T3),HR and MAP levels in 4 groups were increased compared with T0(P<0.05);MAP at T2,A2>A1,B1,B2>B1,P<0.05;Heart rate at T1,A2,B2>A1 and B1;at T2,A2,B2>A1 and B1;at T3,A2,B2>A1 and B1,P<0.05;VAS score 1 h after surgery,B1<A1<B2<A2 group;At 6 h after operation,B1<A1,B2<A2;24 h after surgery,B1<A1,B2<A2,P<0.05;There was no significant difference in the levels of WBC,Glu,CRP,IL⁃6 and TNF⁃αat T0 time point(P>0.05).Blood glucose in 1 h postoperatively,B1<A1,B2<A2;6 h postop⁃eratively,B1<A1,B2<A2;24 h postoperatively,B1<A2,B2,A1<A2;P<0.05;WBC in group A2>B2>A1>B1 at 1 h after surgery,group A2,B2>A1>B1 at 6 h after surgery,group A2>B2>A1>B1 at 24 h after surgery,P<0.05;The levels of CRP,IL⁃6 and TNF⁃αwere B1<A1<B2<A2 group 1 h,6 h and 24 h after surgery,P<0.05;There was no statisti⁃cal significance in the incidence of nausea,vomiti
作者
高洋
郝丽
马鸿雁
郭力甲
石景辉
GAO Yang;HAO Li;MA Hong-yan;GUO Li-jia;SHI Jing-hui(Department of Anesthesiology,Qunli Hospital of The First Affiliated Hospital of Harbin Medi-cal University,Harbin 150070,China;Department of Thyroid Surgery,Qingdao Central Hospital of University of Health and Rehabilitation Sciences,Qingdao 266042,China)
出处
《哈尔滨医科大学学报》
CAS
2024年第1期59-63,共5页
Journal of Harbin Medical University
基金
中华口腔医学会青年临床科研基金(CSA-A2021-10)。
关键词
多模式镇痛
口腔癌手术
疼痛评分
应激反应
multimodal analgesia
oral cancer surgery
pain score
stress response
