摘要
目的评价双氯芬酸钠用于多模式镇痛对老年患者结肠癌根治术后认知功能的影响。方法选择拟行全麻下开腹乙状结肠癌手术患者60例,年龄65~80岁,性别不限,体重45~85kg,ASA分级Ⅰ级或Ⅱ级,采用随机数字表法分为2组(n=30):对照组和试验组。试验组术前应用双氯芬酸钠栓直肠给药,置入至肛门齿状线上约2~3cm处,于术前2h、术后4h时各给药1次,每次50mg,随后每12h给药1次,直至术后2d。术后行PCIA,若术后48h内VAS评分>4分则静脉注射地佐辛5mg。于术前(T0)、术后2、6、12、24及48h(T1-5)时采用ELISA法测定血清IL-6、IL-8和TNF-α的浓度。记录术后补救镇痛情况、患者术后镇痛满意度评分、肛门排气时间和下床活动时间等。于术前1 d和术后7d时测试认知功能,记录术后认知功能障碍的发生情况。结果与对照组比较,试验组T2-5时血清IL-6浓度、T1-5时血清IL-8浓度、T2-4时血清TNF-α浓度降低,补救镇痛率和术后认知功能障碍发生率降低,肛门排气时间及下床活动时间缩短(P<0.05)。结论双氯芬酸钠用于多模式镇痛可改善老年患者结肠癌根治术后认知功能。
Objective To evaluate the effect of multimodal analgesia with diclofenac sodium on cognitive function following radical resection for colon cancer in elderly patients.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of either sex,aged 65-80 yr,weighing 45-85 kg,scheduled for elective open sigmoidectomy under general anesthesia,were divided into control group and test group by a random number table method with 30 patients in each group.In test group,diclofenac sodium suppository was administrated rectally before surgery and placed at about 2 to 3cm above the anal dentate line,diclofenac sodium suppository 50mg was given at 2h before surgery and 4h after surgery, followed by administration once every 12 h until 2 days after surgery.Patient-controlled intravenous analgesia was performed after operation,dezocine 5mg was intravenously injected when VAS score was more than 4 points within 48h after surgery.The concentrations of serum interleukin-6(IL-6),IL-8 and tumor necrosis factor-alpha (TNF-α)were measured by enzyme-linked immunosorbent assay before surgery (T0)and at 2,6,12,24 and 48h after surgery (T1-5).The postoperative requirement for rescue analgesia,postoperative analgesia satisfaction score,time of passing the first flatus and first postoperative off-bed time were recorded.Cognitive function was assessed at 1 day before surgery and 7days after surgery,and the occurrence of postoperative cognitive dysfunction was recorded.Results Compared with control group,the serum concentrations of IL-6 at T2-5,IL-8 at T1-5 and TNF-α at T2-4 were significantly decreased,the requirement for rescue analgesia and incidence of postoperative cognitive dysfunction were decreased,and the time of passing the first flatus and first postoperative off-bed time were shortened in test group (P<0.05).Conclusion Diclofenac sodium for multimodal analgesia can improve cognitive function following radical resection for colon cancer in elderly patients.
作者
容雄飞
张江玲
孟凡民
张加强
Rong Xiongfei;Zhang Jiangling;Meng Fanmin;Zhang Jiaqiang(Department of Anesthesiology,People's Hospital of Zhengzhou University,Zhengzhou 450003,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2018年第9期1049-1052,共4页
Chinese Journal of Anesthesiology
关键词
二氯酚酸
镇痛
认知障碍
结肠肿瘤
老年人
Diclofenac
Analgesia
Cognition disorders
Colonic neoplasms
Aged
作者简介
通信作者:张加强,Email:hnmzxh@163.com
