右美托咪定用于食管癌根治术后PCIA对机体炎症反应的影响

目的:探讨右美托咪定用于食管癌根治术后PCIA对机体炎症反应的影响.方法:选择2014年3月至2015年12月在我院行食管癌根治术的患者80例,年龄50~70岁,ASA分级Ⅰ~Ⅱ级,随机均分为两组,吗啡镇痛组(M组,n=40)和右美托咪啶联合吗啡镇痛组(DM组,n=40).术后两组患者均经静脉自控镇痛(PCIA),M组采用吗啡0.03mg/kg/h,DM组采用吗啡0.03mg/kg/h复合右美托咪啶1ug/kg/d,均用0.9%生理盐水配至150mL.分别在术前1d(T1)、术后6h(T2)、术后24h(T3)和术后72h(T4)抽取外周静脉血检测炎症因子IL-6和TNF-α表达水平.在T2~T4时点对患者采用视觉模拟评分法(VAS评分)评估镇痛效果,记录镇痛期间内的吗啡用量.结果:与M组比较,DM组患者术后T2~T4时VAS评分、吗啡用量、IL-1和TNF-α表达均明显降低(P<0.05);与T1时点基础值比较,两组患者在T2~T4时点的IL-6和TNF-α表达水平均升高(P<0.05).结论:右美托咪定可有效缓解食管癌根治术术后疼痛,降低镇痛时吗啡用量和机体的炎症反应.

Effects of Dexmedetomidine PCIA on Inflammatory Reaction in Esophageal Cancer Surgery

Objective:To investigate the effects of dexmedetomidine patient-controlled intravenous an-algesia on inflammatory reaction in esophageal cancer surgery. Methods:80 patients ( aged 50~70, ASAⅠ~Ⅱ) scheduled for esophageal cancer surgery were randomly divided into 2 groups ( in each group):morphine group ( group M, n=40) and dexmedetomidine and morphine group ( group DM, n=40) . PCIA were used in both groups after surgery. Group M were pumping morphine with 0. 3mg/kg/h, group DM were pumping dexmedetomidine 1μg/kg/d and morphine 0. 3mg/kg/h, both of them were dilutioned to 150 ml with 0. 9%normal saline.The expressions of IL-1 and TNF-α in venous blood were tested on the preoperative 1 day ( T1 ) , postoperation 6 hour ( T2 )、24 hour ( T3 ) and 72 hour ( T4 ) . And the scores of visual analog scale ( VAS) and the dosage of morphine were evaluated on T2~T4 . Results:Compared with group M, the VAS score, the dosage of morphine and the expressions of IL-6 and TNF-αwere decreased and IL-1 and TNF-αwere increased on T2~T4 in group DM ( P<0.05) . Compared with T1 , the expressions of IL-1 and TNF-αon T2~T4 were increased in two groups ( P<0.05) . Conclusion:The dexmedetomidine can relieve the pain after esophageal cancer surgery, and decrease the dosage of morphine and inflammatory reaction of body.