摘要
目的探讨右美托咪定复合罗哌卡因在结肠癌术后镇痛中的应用价值。方法采用随机数字表法将118例结肠癌患者分为A组和B组,每组各59例。A组术后给予罗哌卡因硬膜外镇痛,B组术后给予右美托咪定复合罗哌卡因硬膜外镇痛。观察两组手术时间、术中出血量、术中麻醉药物用量、术后1 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)时视觉模拟法疼痛评分(VAS)、麻醉前(t0)、术后1 h(t1)、24 h(t2)、48 h(t3)、72 h(t4)时血清皮质醇(Cor)、C反应蛋白(CRP)和白细胞介素-6(IL-6)水平。结果两组手术时间、失血量、术中七氟醚、舒芬太尼用量相比较,差异均无统计学意义(P>0.05)。B组T2~T5时VAS疼痛评分与A组相比较均显著降低(P<0.05)。t2~t4时B组CD4^+T细胞和CD4^+/CD8^+均高于同期A组(P<0.05),CD8^+T细胞均低于同期A组(P<0.05)。t2~t4时B组Cor、CRP、IL-6水平均低于A组(P<0.05)。结论右美托咪定复合罗哌卡因用于结肠癌术后硬膜外镇痛可提高镇痛效果,减轻术后应激水平,降低炎症因子水平,改善细胞免疫功能,有利于患者术后康复,值得临床推广应用。
Objective To study the value of dexmedetomidine combined with ropivacaine in postoperative analgesia of colon cancer. Methods 118 patients with colon cancer were randomly divided into the group A and group B with 59 patients in each group. The group A was given epidural analgesia with ropivacaine, and the group B was treated with dexmedetomidine and ropivacaine for epidural analgesia after operation. Observe and record the operation time, amount of intraoperative bleeding and dosage of anaesthetic drugs during operation, visual analogue pain score （VAS） at 1 h （T1）, 6 h （T2）, 12 h （T3）, 24 h （T4） and 48 h（T5） after operation, and the serum cortisol （Cor）, C reac-tive protein （CRP） and interleukin -6 （IL-6） levels at pre anaesthesia （t0） and 1 h （t1）, 24 h （t2）, 48 h （t3）, 72 h （t4） after operation in the two groups. Results There was no significant difference in operation time, blood loss, the dosage of sevoflurane and sufentanil during operation between the two groups （P〉0.05）. At T2 to T5, The pain score of VAS in group B was significantly lower than that in group A （P〈0.05）. At t2 to t4, the levels of CD4＋ T cells and CD4＋/CD8＋ in group B were higher than those in group A （P〈0.05）, while the level of CD8＋ T cells in group B were lower than those in group A （P〈0.05）. At t2 to t4, the levels of Cor, CRP and IL-6 in group B were lower than that in group A （P〈0.05）. Conclusion The dexmedetomidine combined with ropivacaine for postoperative epidural analgesia in treatment of colon cancer can improve the analgesic effect, relieve postoperative stress level, reduce inflammatory factors level, and improve cellular immune function. It is conducive to postoperative rehabilitation, and is worthy of clinical application..
作者
李爱国
陈治军
蒋奕红
贺亮
邹良群
黄子津
LI Aiguo;CHEN Zhijun;JIANG Yihong;HE Liang;ZOU Liangqun;HUANG Zijin(Department of Anesthesiology;Department of Oncology, the Affiliated Hospital of Guilin Medical College, Guilin Guangxi, 541000, China;Department of Anesthesiology, the Second Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530007, China)
出处
《肿瘤药学》
CAS
2018年第2期179-183,共5页
Anti-Tumor Pharmacy
基金
广西自然科学基金(2015jj AA40020)
国家自然科学基金资助项目(81303103)
关键词
结肠癌
腹腔镜手术
右美托咪定
罗哌卡因
应激反应
细胞免疫功能
Colon cancer
Laparoscopic surgery
Dexmedetomidin
Ropivacaine
Stress response
Cellular immune function
作者简介
李爱国,男,硕士,主治医师,研究方向：麻醉及肿瘤患者术后镇痛,E-mail：liaiguo669@163.com.;通讯作者：贺亮,男,副主任医师,研究方向：临床麻醉,E-mail：jimyliang@hotmail.com.
