三种镇痛法对胃癌根治术患者术后镇痛效果及血浆IL-6的影响

目的 比较硬膜外超前镇痛复合术后硬膜外镇痛、单纯术后硬膜外镇痛及单纯术后静脉镇痛的效果,及其对术后血浆白细胞介素-6(IL-6)浓度的影响.方法 66例择期行胃癌根治术患者,ASAⅠ～Ⅱ级,年龄33～60岁,随机均分为3组:(1)超前镇痛组即硬膜外超前镇痛复合术后硬膜外镇痛;(2)单纯术后硬膜外镇痛;(3)术后静脉芬太尼镇痛.记录3组围术期的血流动力学变化;术后4、8、16、24、48和72 h各时间点静息时和咳嗽时视觉模拟(VAS)评分,测定术前、术后24、48、72 h血浆IL-6值.结果 3组术后血流动力学变化相似;术后VAS评分及IL-6增高,超前镇痛组VAS和IL-6均低于单纯术后硬膜外镇痛组,单纯术后硬膜外镇痛组均低于术后静脉芬太尼镇痛组(P＜0.05).结论 硬膜外超前镇痛复合术后硬膜外镇痛比单纯术后硬膜外镇痛和静脉镇痛具有更好的镇痛和抗炎效果.

Comparison of three analgesic methods for postoperative pain relief and their effects on plasma interleukin-6 concentration following radical surgery for gastric carcinoma

Objective To compare the efficacy of preemptive epidural analgesia combined with postoperative epidural analgesia,postoperative epidural analgesia alone and intravenous analgesia for postoperative pain relief and their effects on plasma interleukin-6(IL-6)concentration following radical surgery for gastric carcinoma.Methods Sixty-six patients with gastric carcinoma scheduled for gastroectomy were randomly divided into 3 groups,namely group P(n=22),group E(n=22)and group V(n=22),to receive preemptive epidural analgesia combined with postoperative epidural analgesia,exclusive postoperative epidural analgesia,and exclusive postoperative intravenous analgesia,respectively.Hemodynamic data were recorded for all the patients during the operation,and visual analogue scale(VAS)was used to assess the pain intensity at 4,8,16,24,48 and 72 h after surgery.Plasma IL-6 concentration was determined before surgery and at 24,48,72 h after surgery.Results No significant changes occurred in the hemodynamics during the preoperative periods.VAS and IL-6 were lower in group P than in group E and V,and group E had lower measurement than group V(P<0.05).Conclusion Preemptive epidural analgesia combined with postoperative epidural analgesia provides more satisfactory pain relief and more effectively prevents IL-6 increment than exclusive epidural analgesia or intravenous analgesia after gastrectomy for gastric carcinoma.