不同药物术后自控镇痛对腹腔镜胆囊切除术后患者IL-2、IL-6、IL-10的影响

目的通过观察不同药物术后自控镇痛对腹腔镜胆囊切除术（LC）后息者血浆中细胞因子变化的影响，探讨术后充分镇痛对炎性应激反应的影响。方法根据药物与镇痛方法不同，将120例行LC患者用抽签法随机分为3组（每组40例）：对照组（组1）患者术后根据需要临时给予哌替啶50mg肌肉注射镇痛。舒芬太尼组（组Ⅱ）患者术后予舒芬太尼静脉自控镇痛。曲马多组（组Ⅲ）患者术后予曲马多静脉自控镇痛。观察麻醉前30min、手术后即刻、术后24h和72h4个时点患者血浆中自细胞介素-2（IL-2）、白细胞介素-6（IL-6）、白细胞介素-10（1L-10）水平，并以视觉模拟评分法（VAS）评价各组患者术后2、24、48、72h的镇痛效果。结果术后各时点组Ⅱ、组Ⅲ的VAS均显著低于组Ⅰ（均P〈0．05）。但组Ⅱ、组Ⅲ间的差异无统计学意义（P〉0．05）；3组患者术毕即刻至术后72h血浆IL-2水平较麻醉前均明显降低（均P〈0．05），但组Ⅱ、组Ⅲ术后24h及72h的水平均高于组Ⅰ（均P〈0．05）。3组患者术毕即刻IL-6、IL-10水平较麻醉前均明显升高（均P〈0．01），并持续升高至术后24h达峰值后逐渐下降，但术后72h各组IL-6、IL-10水平仍高于术前（均P〈0．05）。与组Ⅰ比较，组Ⅱ和组ⅢIL-6、IL-10水平增高的幅度均显著降低（均P〈0．05）。结论术后经静脉自控镇痛模式较传统镇痛模式满意度好，且能更有效地减轻LC术后炎性应激反应。

Blood IL-2, IL-6 and IL-10 levels in patients with patient-controlled- anesthesia after laparascopic cholecystectomy

Objective To investigate the efficacy and stress reactions of patient-controlled-anesthesia （PCA） with different anesthetic agents in patients undergoing laparoscopic cholesystectomy （LC）. Methods A total of 120 patients undergoing LC were randomly divided into 3 groups （n=40 in each） based on the different analgesic strategies. Group Ⅰ （control group） received pethidine i.m after surgery when necessary; group Ⅱ （sufentanil group） were given with sufentanil Ⅳ-PCA; while group Ⅲ （tramadol group） with tramadol Ⅳ-PCA. Blood interleukin-2 （IL-2）, IL-6 and IL-10 levels were measured at 30 min before anesthesia, immediately after surgery, 24 h and 72h after surgery. The analgesic degrees were evaluated according to visual analogue scale （VAS） at 2h, 24h, 48h and 72h after surgery. Results VAS scores of group Ⅱ and group Ⅲ were significantly lower than that of group Ⅰ at all time points （P〈0.05）, there was no significant difference between group Ⅱ and Ⅲ （P 〉0.05）. Compared with pre-anesthesia, the levels of IL-2 at all time points were significantly lower in all 3 groups （P〈0.05）; however, it was significantly higher in groups Ⅱ and Ⅲ than in group Ⅰ 24h and 72h after surgery （P〈0.05）. The levels of IL-6 and IL-10 immediately after surgery were significantly higher than those pre-anesthesia （P〈0.01）, which kept increasing until 24h after surgery. But it was also higher of 72h after surgery. Compared with group Ⅰ , the levels of IL-6 and IL-10 were significantly lower in groups Ⅱ and Ⅲ. Conclusion Compared with conventional analgesic method, Ⅳ-PCA can effectively relieve pain and reduce the inflammatory stress reaction after surgery.