摘要
目的:观察氯诺昔康用于上腹部手术后镇痛的临床效果及对术后炎性细胞因子表达的影响。方法:60例上腹部手术患者,随机分为3组,吗啡组20例,手术结束使用吗啡患者自控镇痛(PCA)泵(负荷剂量0.05mg/kg,冲击剂量1mg,锁定时间10m in,背景剂量为0);氯诺昔康术后给药组20例,手术结束静脉注射氯诺昔康8mg,同时使用吗啡PCA泵,设置同吗啡组,术后12、24、36 h分次静脉注射氯诺昔康8mg;氯诺昔康预给药组20例,手术开始前30m in静脉注射氯诺昔康8mg,手术结束时使用吗啡PCA泵,设置同吗啡组,术后12、24、36 h分次静脉注射氯诺昔康8mg。记录各组术后4、8、12、24和48 h静息视觉模拟评分(VAS)、吗啡用量及不良反应。分别随机抽取三组各6例患者,手术开始前和手术结束后2、6、12、24 h的静脉血2 m l,测定血白细胞介素-6(IL-6)、IL-10的浓度。结果:术后至术后48 h,三组患者静息VAS无统计学意义。各时段吗啡总用量:吗啡组均高于氯诺昔康术后给药组及氯诺昔康预给药组(P<0.05),而氯诺昔康术后给药组又高于氯诺昔康预给药组,但无统计学意义。术后胃肠道不良反应发生率三组患者相似。三组患者术前IL-6、IL-10几乎测不到,术后2 h,三组患者血浆IL-10均达峰值,但吗啡组明显低于氯诺昔康术后给药组及氯诺昔康预给药组(P<0.05)。术后6 h,三组患者IL-6达峰值,其中吗啡组明显高于氯诺昔康术后给药组及氯诺昔康预给药组(P<0.05),12 h吗啡组仍明显高于氯诺昔康预给药组(P<0.05)。结论:术前预给予氯诺昔康可明显减少上腹部术后镇痛的吗啡用量,并减轻术后炎性细胞因子的反应。
Objective： To investigate the analgesic effect and impact of lomoxicam on the expression of plasma IL-6 and IL-10 in patients undergoing upper abdominal surgery. Methods：Sixty patients under- going upper abdominal surgery were randomly allocated into three groups, morphine group （M, n = 20 ）, postoperative lornoxicam group （ L, n = 20） and preemptive lomoxicam group （ P, n = 20）. For group M the subjects received patient controlled intravenous analgesia （PCIA） with morphine （ loading dose 0.05 mg/kg, bolus 1 mg, lockout time 10 min, background dose 0 mg） after the surgery. While in group L, 8 mg lomoxiam was administered at the end of the surgery, then the same morphine PCIA scheme as in group M was used in combination with intermittent intravenous lomoxiam （8 mg per injection） at 12, 24 and 36 h after the surgery. Except that the first 8 mg lomoxicam was injected 30 min before the operation,the analgesic paradigm of group P was similar to group L. The analgesic effect assessed by VAS at rest, the consumed dosage of morphine, and the adverse effects as nausea and vomiting, were recorded at 4, 8, 12, 24 and 48 h. Furthermore, 2 ml of the venous blood was drawn before the induction of anesthesia 2, 6, 12, and 24 h after the surgery to measure the levels of interleukin 6 （IL-6） and interleukin 10 （IL-10）. Results： During the 48 h observation, the VAS at rest was not statistically significant in the three groups, but more morphine was consumed in group M than in group L and group P. There was no difference among the three groups in the incidence of such adverse effects as nausea or vomiting. The basic levels of IL-6 and IL-10 were too low to be measured. The concentrations of IL-IO and IL-6 reached the peak at 2 and 6 h after surgery respectively, and the level of IL-10 in group M was significantly lower than in groups L and P at 2 h. In contrast, the level of IL-6 in group M was significantly higher than in group L and group P at 6 h, and even higher than in group P at 12 h. Conclusion ： Lornoxicam, especially when administered before upper abdominal operation, could significantly decrease the dose of morphine for postoperative analgesia and attenuate the inflammatory cytokine response after surgery.
出处
《医学研究生学报》
CAS
2007年第10期1057-1060,I0006,共5页
Journal of Medical Postgraduates
基金
南京军区南京总医院科研基金资助项目(批准号:2003077)
关键词
氯诺昔康
术后镇痛
超前镇痛
炎性反应
细胞因子
Lornoxicam
Postoperative analgesia
Preemptive analgesia
Inflammtory response
Cytokine
