地佐辛对老年开胸手术患者围术期炎性细胞因子和术后镇痛的影响

目的观察地佐辛对老年开胸手术患者围术期炎性细胞因子和术后镇痛效果的影响。方法将40例择期全麻下行肺癌和食管癌根治术的老年患者随机分为地佐辛组（A组）和对照组（B组）,各20例。两组患者分别于麻醉诱导前（T1）、术后4 h（T2）、12 h（T3）、24 h（T4）、采取静脉血,测定血清肿瘤坏死因子-α（TNF-α）及白细胞介素-6（IL-6）、IL-10的浓度。于T1～4记录视觉模拟评分（VAS）,观察两组各点平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）变化及术后循环和呼吸系统并发症的发生情况。结果两组炎性细胞因子TNF-α、IL-6浓度T2时点明显高于T1（P〈0.05）,IL-10浓度T3、T4时点明显高于T1（P〈0.05）。与B组相比,A组T3、T4时点TNF-α、IL-6浓度均较低（P〈0.05）,IL-10浓度较高（P〈0.05）;A组T3、T4时点VAS评分明显低于B组（P〈0.05）;A组患者术后循环和呼吸系统并发症明显减少。结论地佐辛用于老年开胸手术产生明显的镇痛作用,可减轻围术期的炎性反应,调节免疫平衡,且术后循环和呼吸系统并发症明显减少。

Effects of Dezocine on inflammatory factors and postoperative analgesia in old patients undergoing open thoracotomy

Objective To investigate the efficacy of Dezocine on inflammatory factors and postoperative analgesia in old patients undergoing open thoracotomy.Methods Forty patients received lung cancer surgery and cancer of the esophagus under general anesthesia were randomly divided into Dezocine group（group A,n=20） and control group（group B,n=20）.TNF-α,IL-6 and IL-10 in plasma in each group were measured immediately before induction of anesthesia（T1）,4 h（T2）,12 h（T3） and 24 h（T4） after operation.The analgesic effect assessed by visual analog scale（VAS） at T1-4.The MAP,HR and SpO2 were monitored at the same time.The adverse effects were observed with in 24 h after operation.Results TNF-α and IL-6 of the two groups at T2 were significantly increased compare to T1（P0.05）,while IL-10 at T3 and T4 were significantly increased compare to T1（P0.05）.The TNF-α and IL-6 at T3 and T4 were significantly lower（P0.05）,as well as IL-10 were significantly higher at the same time in the group A than in the group B（P0.05）.The VAS pain scores in the group A were significantly lower than those in the group B at T3 and T4,respectively（P0.05）.The adverse effects after operation of group A were reduced significantly.Conclusion Dezocine has a good postoperative analgesic effect,and can effectively relieve inflammatory reaction without serious adverse effects after operation for old patients un dergoing open thoracotomy.