摘要
目的观察舒芬太尼联合托烷司琼术后镇痛对腹部择期全身麻醉手术患者围术期白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)及胰岛素敏感指数(ISI)的影响。方法选取2016年3月至2017年3月于山西省人民医院行择期腹部手术患者120例,所有患者采用全身麻醉的麻醉方法,将患者按照随机数字表法分成对照组和观察组,每组60例,对照组患者采用按需给药的术后镇痛方法,观察组患者采用舒芬太尼联合托烷司琼术后镇痛泵的术后镇痛方法,对比两组患者术毕和术后BCS舒适评分(BCS评分)、视觉模拟评分(VAS评分)、睡眠障碍镇静评分(Ramsay评分),术前和术后的TNF-α水平、ISI、IL-6水平、胰岛素水平和血糖水平。结果观察组术后0.5 d[(2.78±0.57)分、(2.27±0.39)分]、术后1 d[(3.04±0.48)分、(2.36±0.50)分]、术后1.5 d[(3.24±0.51)分、(2.43±0.49)分]、术后2 d[(3.35±0.43)分、(2.51±0.42)分]的BCS评分和Ramsay评分升高(t=-18.604、-8.65、-8.204、-3.967,t=-9.634、-4.864、-4.610、-2.604,均P<0.05),与对照组相比,观察组术后0.5 d[(2.4±1.1)分]、术后1 d[(1.8±0.8)分]、术后1.5 d[(1.7±0.5)分]、术后2 d[(1.7±0.9)分]的VAS评分降低(t=2.082、4.834、7.934、3.098,均P<0.05)。与对照组相比,观察组术后0.5 d[(7.26±2.17)mU/L,(5.63±0.58)mmol/L,(148.96±20.31)μg/L,(120.54±22.27)pg/mL]、术后1 d[(7.37±1.74)mU/L,(5.34±0.50)mmol/L,(121.35±21.07)μg/L,(116.35±21.01)pg/mL]、术后1.5 d[(6.57±2.14)mU/L,(5.11±0.50)mmol/L,(114.36±23.99)μg/L,(113.14±18.05)pg/mL]、术后2 d[(5.87±1.84)mU/L,(4.87±0.51)mmol/L,(100.02±18.13)μg/L,(91.37±14.88)pg/mL]的胰岛素、血糖、TNF-α、IL-6的水平降低(t=9.374、11.698、6.455、10.161,t=8.557、13.027、9.990、8.541,t=6.730、7.917、7.811、2.326,t=8.003、7.225、3.839、-7.618,均P<0.05),与对照组相比,观察组术后0.5 d[(24.77±0.26)×1000]、术后1 d[(25.03±0.21)×1000]、术后1.5 d[(29.65±0.17)×1000]、术后2 d[(34.54±0.19)×1000]的ISI的水平升高(t=-281.912、-442.121、-248.226、-431.857,均P<0.05)。结论舒芬太尼联合托烷司琼术后镇痛泵的镇痛全身麻醉效果好,能很好地减轻术后应激反应和降低IL-6、TNF-α的水平,减轻胰岛素抵抗程度,可广泛应用于临床。
Objective To investigate the effect of sulfentanyl and tropisetron postoperative analgesia pump on perioperative interleukin 6(IL-6),tumor necrosis factor(TNF-α)and insulin resistance in patients undergoing abdominal general anesthesia.Methods From March 2016 to March 2017,120 patients undergoing elective abdominal surgery in our hospital were selected,all patients were treated with general anesthesia.The patients were randomly divided into control group and observation group according to the digital table,with 60 cases in each group.The control group was treated with on-demand delivery analgesia.The observation group was treated with sulfentanyl and tropisetron postoperative analgesia pump for postoperative analgesia.The BCS score,VAS score,Ramsay score at the end of operation and after operation were compared.The TNF-α,ISI,IL-6,insulin levels and blood glucose levels of preoperation and postoperation were compared between the two groups.Results Compared with the control group,the BCS score and Ramsay score of postoperative 0.5d[(2.78±0.57)points,(2.27±0.39)points],postoperative 1d[(3.04±0.48)points,(2.36±0.50)points],postoperative 1.5d[(3.24±0.51)points,(2.43±0.49)points],postoperative 2d[(3.35±0.43)points,(2.51±0.42)points]in the observation group increased(t=-18.604,-8.65,-8.204,-3.967,t=-9.634,-4.864,-4.610,-2.604,all P<0.05),the VAS scores of postoperative 0.5d[(2.4±1.1)points],postoperative 1 d[(1.8±0.8)points],postoperative 1.5d[(1.7±0.5)points],postoperative 2d[(1.7±0.9)points]in the observation group were lower(t=2.082,4.834,7.934,3.098,all P<0.05).Compared with the control group,the insulin,blood sugar,TNF-α,IL-6 of postoperative 0.5d[(7.26±2.17)mU/L,(5.63±0.58)mmol/L,(148.96±20.31)g/L,(120.54±22.27)pg/mL],postoperative 1d[(7.37±1.74)mU/L,(5.34±0.50)mmol/L,(121.35±21.07)μg/L,(116.35±21.01)pg/mL],postoperative 1.5d[(6.57±2.14)mU/L,(5.11±0.50)mmol/L,(114.36±23.99)μg/L,(113.14±18.05)pg/mL],postoperative 2d[(5.87±1.84)mU/L,(4.87±0.51)mmol/L,(100.02±18.13)μg/L,(91.37±14.88)pg/mL]in the observation group were lower(t=9.374,11.698,6.455,10.161,t=8.557,13.027,9.990,8.541,t=6.730,7.917,7.811,2.326,t=8.003,7.225,3.839,-7.618,all P<0.05).Compared with the control group,the ISI of postoperative 0.5d[(24.77±0.26)×1000],postoperative 1d[(25.03±0.21)×1000],postoperative 1.5d[(29.65±0.17)×1000],postoperative 2d[(34.54±0.19)×1000]in the observation group were increased(t=-281.912,-442.121,-248.226,-431.857,all P<0.05).Conclusion The analgesic effect of sulfentanyl and tropisetron postoperative analgesia pump is good,it can reduce the postoperative stress response and the levels of IL-6 and TNF-α,and reduce the degree of insulin resistance,and can be widely used in clinical.
作者
卫建峰
郑李娜
Wei Jianfeng;Zheng Lina(Department of Anesthesia,the People's Hospital of Shanxi Province,Taiyuan,Shanxi 030012,China)
出处
《中国基层医药》
CAS
2020年第2期183-187,共5页
Chinese Journal of Primary Medicine and Pharmacy
