摘要
目的:研究舒芬太尼联合布托啡诺静脉自控镇痛对中低位直肠癌患者术后疼痛程度及镇静评分的影响。方法:选取2015年10月—2018年3月我院收治的中低位直肠癌患者86例,采用随机数字表法分为对照组和研究组,各43例。两组均行气管插管全麻下直肠癌根治术,对照组术后采用舒芬太尼静脉自控镇痛,研究组术后采用舒芬太尼联合布托啡诺静脉自控镇痛。比较两组术后舒芬太尼用量、第1次需要按压镇痛泵距拔管时间、疼痛程度(VAS评分)、Ramsay镇静评分、舒适度(BCS评分)、不良反应发生率、应激反应指标[血清生长激素(GH)、皮质醇(FC)水平]及免疫功能指标(外周血CD3^+、CD4^+)水平。结果:研究组舒芬太尼用量少于对照组,第1次需要按压镇痛泵距拔管时间长于对照组,差异有统计学意义(P<0.05);术后6 h、12 h、24 h,研究组VAS评分均低于对照组,Ramsay及BCS评分高于对照组,差异有统计学意义(P<0.05);术后12 h,两组血清GH、FC水平均高于术毕即刻,但研究组低于对照组,差异有统计学意义(P<0.05);两组外周血CD3^+、CD4^+水平均低于术毕即刻,但研究组高于对照组,差异有统计学意义(P<0.05);研究组不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论:舒芬太尼联合布托啡诺静脉自控镇痛能有效缓解中低位直肠癌患者术后应激反应及免疫抑制作用,有效减轻患者疼痛程度,改善镇静效果及舒适度,且能减少舒芬太尼用量,延长镇痛时间,安全性高。
Objective:To study the effect of sufentanil combined with butorphanol for patient controlled intravenous analgesia on postoperative pain and sedation scores in patients with middle and low rectal cancer.Methods:86 patients with middle and low rectal cancer admitted to our hospital from October 2015 to March 2018 were selected and randomly divided into a control group and a study group,43 cases each.The patients in the two groups underwent radical resection of rectal cancer under general anesthesia with tracheal intubation.The patients in the control group were treated with sufentanil for patient controlled intravenous analgesia after surgery,and the patients in the study group were treated with sufentanil combined with butorphanol for patient controlled intravenous analgesia.The dosage of sufentanil after surgery,the time between the first time of pressing the analgesia pump and extubation,the degree of pain(VAS score),Ramsay sedation score,the degree of comfort(BCS score),the incidence of adverse reactions,stress response indexes[serum growth hormone(GH),cortisol(FC)levels]and immune function indexes(peripheral blood CD3^+,CD4^+levels)were compared between the two groups.Results:The dosage of sufentanil in the study group was less than that in the control group,and the time between the first time of pressing the analgesia pump and extubation was longer than that in the control group,with statistically significant differences(P<0.05).6 h,12 h and 24 h after surgery,the VAS scores in the study group were lower than those in the control group,while the Ramsay and BCS scores were higher than those in the control group,with statistically significant differences(P<0.05).The levels of serum GH and FC 12 h after surgery were higher than those immediately after surgery in the two groups,but the levels in the study group were lower than those in the control group,with statistically significant differences(P<0.05).The levels of CD3^+and CD4^+in the peripheral blood in the two groups were lower than those immediately after surgery,but the levels in the study group were higher than those in the control group,with statistically significant(P<0.05).The total incidence of adverse reactions in the study group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:Sufentanil combined with butorphanol for patient-controlled intravenous analgesia can effectively alleviate postoperative stress response and immunosuppressive effect in the patients with middle and low rectal cancer,effectively alleviate the degree of pain,improve the sedation effect and comfort degree,reduce the dosage of sufentanil and prolong the analgesic time,and has high safety.
作者
邹磊
Zou Lei(Department of Anesthesiology,Xinyang Central Hospital,Xinyang Henan 464000,China)
出处
《中国合理用药探索》
CAS
2019年第12期88-91,94,共5页
Chinese Journal of Rational Drug Use
关键词
中低位直肠癌
舒芬太尼
布托啡诺
静脉自控镇痛
应激反应
疼痛程度
镇静评分
免疫抑制
Middle and Low Rectal Cancer
Sufentanil
Butorphanol
Patient-controlled Intravenous Analgesia
Stress Response
Pain Degree
Sedation Score
Immunosuppression
