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 |
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引用本文: | 胡桂英,胡崇辉,傅理,徐军,陈元良,吴俊琪. 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[J]. 浙江医学, 2011, 33(11): 1586-1588 |
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作者姓名: | 胡桂英 胡崇辉 傅理 徐军 陈元良 吴俊琪 |
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作者单位: | 金华市中心医院麻醉科,321000 |
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基金项目: | 金华市技术创新工程项目 |
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摘 要: | 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。
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关 键 词: | 镇痛 腹腔镜胆囊切除术 白细胞介素-2 白细胞介素-6 白细胞介素-10 |
Blood IL-2, IL-6 and IL-10 levels in patients with patient-controlled- anesthesia after laparascopic cholecystectomy |
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Affiliation: | HU Guiying, HU Chonghui, FULi, et al. Department of Anesthesiology, Jinhua Central Hospital, Jinhua 321000. China |
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Abstract: | 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. |
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Keywords: | Analgesia Laparoscopic cholecystectomy IL-2 IL-6 IL-10 |
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