右美托咪定联合舒芬太尼自控静脉镇痛对行老年直肠癌根治术的患者术后镇痛效果、炎症反应和早期恢复的影响
| 作者: |
1林志琼,
1杨丽萍,
1刘珊珊,
2涂永久,
1张露含,
1胡宏强
1 中国人民解放军陆军第七十三集团军医院麻醉科，福建 厦门 361000 2 中国人民解放军陆军第七十三集团军医院普外科，福建 厦门 361000 |
| 通讯: |
胡宏强
Email: huhq888888@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2022.01.017 |
| 基金: | 2018年厦门市医疗卫生项目(3502Z20189076)。 |
摘要
目的：探讨右美托咪定联合舒芬太尼自控静脉镇痛(patient-controlled intravenous analgesia，PCIA)对老年直肠癌根治术患者术后镇痛效果、炎症应激反应和早期恢复的影响。方法：选取2019年1月至2020年12月在中国人民解放军陆军第七十三集团军医院择期行腹腔镜直肠癌根治术的患者100例为研究对象，随机分为对照组(n=50)与观察组(n=50)；两组术后均予以PCIA，对照组配方为舒芬太尼3.0 μg/kg+托烷司琼10 mg，观察组配方为舒芬太尼3.0 μg/kg+右美托咪定1.0 μg/kg+托烷司琼10 mg，均经生理盐水稀释至100 mL，维持疼痛视觉模拟(Visual Analogue Scale，VAS)评分≤3。比较两组镇痛效果、术后3 d 恢复质量量表(15-item Quality of Recovery Questionnaire，QoR-15)评分、炎症因子[白细胞介素-6(interleukin-6，IL-6)、IL-1β、肿瘤坏死因子-α(tumor necrosis factor-alpha，TNF-α)]水平及不良反应。结果：相比对照组，观察组术后4 h、12 h、24 h、48 h的VAS评分及术后补救镇痛率均降低，术后24 h舒芬太尼用量减少，且术后下床时间、首次排气时间均提前，术后3 d的QoR-15评分增高，差异均有统计学意义(P<0.05)；术后，两组血清IL-6、IL-1β、TNF-α水平均增高，但观察组相比对照组较低，差异均有统计学意义(P<0.05)；观察组术后恶心呕吐、总不良反应发生率分别为10.00%、18.00%，均低于对照组的28.00%、44.00%，差异均有统计学意义(P<0.05)。结论：右美托咪定联合舒芬太尼PCIA可提高老年直肠癌根治术患者术后镇痛效果，减轻炎症应激反应，减少不良反应，有利于术后恢复。
关键词：
右美托咪定；舒芬太尼；自控静脉镇痛；直肠癌根治术；炎症反应；恢复
Effects of dexmedetomidine combined with sufentanil patient-controlled intravenous analgesia on postoperative analgesia, inflammatory stress response and early recovery in elderly patients with rectal cancer undergoing radical operation
CorrespondingAuthor: HU Hongqiang Email: huhq888888@163.com
DOI: 10.3978/j.issn.2095-6959.2022.01.017
Foundation: This work was supported by 2018 Xiamen Medical and Health Project (3502Z20189076), China.
Abstract
Objective: To investigate the effects of dexmedetomidine combined with sufentanil patient-controlled intravenous analgesia (PCIA) on postoperative analgesia, inflammatory stress response and early recovery in elderly patients with rectal cancer undergoing radical resection. Methods: A total of 100 rectal cancer patients undergoing laparoscopic radical resection in our hospital from January 2019 to December 2020 were selected as the research subjects, and they were randomly divided into a control group (n=50) and an observation group (n=50). Both groups were given PCIA after operation, the control group was given sufentanil 3.0 μg/kg + tropisetron 10 mg, and the observation group was given sufentanil 3.0 μg/kg + dexmedetomidine 1.0 μg/kg + tropisetron 10 mg. All the groups were diluted to 100 mL by normal saline, and maintained Visual Analogue Scale (VAS) score ≤3. The analgesic effect, QoR-15 score, inflammatory factors [interleukin-6 (IL-6), IL-1β, tumor necrosis factor-α (TNF-α)] and adverse reactions were compared between the 2 groups. Results: Compared with the control group, the VAS score and postoperative rescue analgesia rate of the observation group at 4 h, 12 h, 24 h and 48 h after operation were decreased, the dosage of sufentanil at 24 h after operation was reduced, the time of getting out of bed and the first exhaust time were advanced, and the QoR-15 at 3 d after operation scores were increased, and the differences were statistically significant (P<0.05). After operation, the levels of IL-6, IL-1β and TNF-α in the two groups were increased, but the levels in the observation group were lower than those in the control group (P<0.05). The incidence of postoperative nausea and vomiting, total adverse reactions in the observation group were 10.00%, 18.00% respectively, which were lower than 28.00% and 44.00% in the control group, and the differences were statistically significant (P<0.05). Conclusion: Dexmedetomidine combined with sufentanil PCIA can improve the postoperative analgesic effect of elderly patients with rectal cancer undergoing radical resection, reduce inflammatory stress reaction, and reduce adverse reactions, and it is conducive to postoperative recovery.
Keywords：
dexmedetomidine; sufentanil; patient controlled intravenous analgesia; radical resection of rectal cancer; inflammatory reaction; recovery