音乐疗法与自控镇痛对肺叶切除术患者围术期炎性反应的影响

目的探讨音乐放松想象训练(MRIT)联合患者静脉自控镇痛技术(PCIA)对行肺叶切除术的肺癌患者围术期血浆肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-10(IL-10)的影响。方法将60例肺叶切除术患者随机分为四组,各15例。A组采取常规护理,术后根据需要间断肌内注射哌替啶镇痛;在此基础上,B组增加MRIT;C组增加术后PCIA;D组采用MRIT联合术后PCIA。采用ELISA法测定术前30min、术毕和术后不同时间的TNF-α、IL-6、IL-10浓度及BP、HR、VAS评分。结果四组不同时段TNF-α、IL-6、IL-10,收缩压、舒张压、HR值及VAS评分比较,干预主效应有统计学意义(均P<0.05),以D组最优。结论围术期实行MRIT联合PCIA能获得较好镇痛效果,维持血流动力学稳定,有效地调控促炎性细胞因子与抗炎性细胞因子之间的平衡,以减轻患者的炎性反应。

Effect of music therapy and patient controlled intravenous analgesia on stress-induced inflammation of patients after lobectomia pulmonalis

Objective To investigate the effect of music-relaxation-imagination therapy(MRIT) combined with patient controlled intravenous analgesia(PCIA) on contents of tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6) and interleukin-10(IL-10) in lung cancer patients after lobectomia pulmonalis.Methods Sixty lung cancer patients scheduled for lobectomia pulmonalis were commensurately and randomly assigned to four groups.Besides routine nursing care,group A received intermittent intramuscular injection of meperidine hydrochloride,group B received MRIT,group C received PCIA,and group D were subjected to MRIT and PCIA.The contents of TNF-α,IL-6 and IL-10 and BP,HR were measured 30 min before the surgery,at completion of the surgery,and at varied postoperative time points.Pain was assessed by using Visual Analog Scale(VAS). Results There were significant group effect in concetrations of TNF-α,IL-6 and IL-10,and in results of SBP,DBP,HR and VAS score in all groups at varied time points(P<0.05 for all),with group D enjoying the best outcome.Conclusion Perioperative MRIT and PCIA can achieve excellent analgesic effect,stabalize hemodynamics,maitain the balance between proinflammatory cytokines and antiinflammatory cytokines,which attenuate inflammatory reaction of patient.