摘要
目的观察喷他佐辛超前镇痛用于脾部分切除术围术期疼痛管理的临床效果。方法选取义乌市中心医院2019年10月至2021年11月行脾部分切除术的创伤性脾破裂患者100例为研究对象,采用随机数字表法分为对照组和研究组,每组50例。两组术后均予以自控泵镇痛,在此基础上,研究组术前增加静脉注射喷他佐辛。记录术中麻醉药物用量及术后麻醉恢复指标,评价术后疼痛反应程度,检测术后血清炎症因子水平,统计术后48 h内自控泵镇痛有效按压次数,观察药物不良反应发生情况。结果研究组术中丙泊酚[(462.24±27.13)mg]和瑞芬太尼用量[(365.98±26.78)μg]均显著少于对照组[(511.82±26.32)mg、(406.86±26.08)μg](t=14.49、12.63,均P<0.001),术后自主呼吸恢复时间[(6.86±0.97)min]、麻醉苏醒时间[(13.24±0.82)min]和拔管时间[(17.14±1.07)min]均显著少于对照组[(7.62±0.90)min、(14.32±0.84)min、(18.22±1.06)min](t=5.80、8.58、6.93,均P<0.001)。研究组术后24 h和48 h静息状态和咳嗽状态视觉模拟评分(VAS)评分均显著低于对照组(t=7.82、9.31、4.95、8.47,均P<0.001);血清肿瘤坏死因子α(TNF-α)、白细胞介素1(IL-1)和白细胞介素6(IL-6)含量均显著低于对照组(t=21.53、25.61、18.45、16.90、17.33、14.86,均P<0.001),而IL-10含量均显著高于对照组(t=-20.85,-19.61,均P<0.001);研究组术后48 h内自控泵镇痛有效按压次数[(6.24±1.17)次]显著少于对照组[(10.26±1.34)次](t=12.95,P<0.05),且药物不良反应总体发生率[4.00%(2/50)]显著低于对照组[18.00%(9/50)](χ^(2)=5.01,P<0.05)。结论对脾部分切除术患者实施喷他佐辛超前镇痛,可有效减少术中麻醉药物和术后镇痛药物给药剂量,促进术后麻醉恢复,抑制术后炎症反应,缓解疼痛反应,降低药物不良反应风险。
Objective To investigate the clinical effect of preemptive analgesia with pentazocine on perioperative pain management in partial splenectomy.Methods A total of 100 patients with traumatic splenic rupture who underwent partial splenectomy at Yiwu Central Hospital between October 2019 and November 2021 were randomly assigned to either the control group or the study group,with 50 patients in each group using the random number table method.Both groups received patient-controlled analgesia postoperatively.Additionally,the study group received intravenous pentazocine administration before surgery.The amount of anesthetic used during surgery,postoperative anesthesia recovery indices,postoperative pain response,serum inflammatory factor levels,and the number of effective patient-controlled analgesia pump presses within 48 hours postoperatively were recorded and evaluated.Any adverse drug reactions were also monitored.Results The dosages of propofol[(462.24±27.13)mg]and remifentanil[(365.98±26.78)μg]in the study group were significantly lower than those in the control group[(511.82±26.32)mg,(406.86±26.08)μg,t=14.49,12.63,both P<0.001].The recovery time of spontaneous breathing[(6.86±0.97)minutes],anesthesia recovery time[(13.24±0.82)minutes]and extubation time[(17.14±1.07)minutes]were significantly shorter than those in the control group[(7.62±0.90)minutes,(14.32±0.84)minutes,(18.22±1.06)minutes,t=5.80,8.58,6.93,all P<0.001].The Visual Analogue Scale(VAS)scores in the study group were significantly lower than those in the control group at 24 and 48 hours after surgery,both in resting and coughing state(t=7.82,9.31,4.95,8.47,all P<0.001).The serum levels of tumor necrosis factor-alpha,interleukin-1,and interleukin-6 were significantly lower in the study group than in the control group(t=21.53,25.61,18.45,16.90,17.33,14.86,all P<0.001),while the serum level of interleukin-10 was significantly higher in the study group than in the control group(t=-20.85,-19.61,both P<0.001).The number of effective patient-controlled pump analgesia presses within 48 hours postoperatively in the study group[(6.24±1.17)times]was significantly lower than that in the control group[(10.26±1.34)times,t=12.95,P<0.05].In addition,the overall incidence of adverse drug reactions in the study group[4.00%(2/50)]was significantly lower than that in the control group[18.00%(9/50),χ^(2)=5.01,P<0.05].Conclusion Preemptive analgesia with pentazocine for patients undergoing partial splenectomy can effectively reduce the dosage of anesthetics during surgery and the dosage of analgesics after surgery,enhance the recovery from postoperative anesthesia,suppress postoperative inflammatory reactions,alleviate pain responses,and minimize the risk of adverse drug reactions.
作者
王建英
陶振云
Wang Jianying;Tao Zhenyun(Department of Anesthesiology,Yiwu Central Hospital,Yiwu 322000,Zhejiang Province,China)
出处
《中国基层医药》
CAS
2024年第4期533-537,共5页
Chinese Journal of Primary Medicine and Pharmacy
关键词
创伤和损伤
脾破裂
脾切除术
喷他佐辛
镇痛
麻醉恢复期
炎症介导素类
药物相关性副作用和不良反应
Wounds and injuries
Splenic rupture
Splenectomy
Pentazocine
Analgesia
Anesthesia recovery period
Inflammation mediators
Drug-related side effects and adverse reactions
