舒芬太尼联合氯胺酮术后静脉镇痛效果及其对血清白细胞介素-6和白细胞介素-10的影响

发布时间：2018-06-07 06:14

本文选题：舒芬太尼 + 氯胺酮　；参考：《中国现代医学杂志》2015年24期

【摘要】：目的观察舒芬太尼联合氯胺酮术后自控静脉镇痛的效果及其对血清IL-6和IL-10的影响。方法择期行上腹部手术的60例患者,随机分为S组、SK组和C组,每组20例。各组均行自控静脉镇痛,负荷量5 ml,背景剂量2 ml/h,PCA 2 ml/次,锁定时间30 min。S组镇痛配方:舒芬太尼2.5μg/kg用0.9%氯化钠溶液稀释至100 ml;SK组镇痛配方:舒芬太尼2μg/kg,氯胺酮2 mg/kg用0.9%氯化钠溶液稀释至100 ml;C组为对照组,镇痛配方:吗啡1.2 mg/kg用0.9%氯化钠溶液稀释至100 ml。分别在术后1、2、4、8、16、24、36、48 h记录患者VAS疼痛评分及不良反应,于麻醉前、术后2、8、24、48 h 5个时间点抽取外周静脉血行血清IL-6、IL-10浓度测定。结果 SK组和S组镇痛效果明显优于C组,且SK组优于S组。不良反应发生率SK组与S组差异无统计学意义(P0.05),明显低于C组(P0.05)。3组患者IL-6和IL-10在术后2~48 h均有明显升高,C组IL-6和IL-10在术后2、8、24 h逐渐升高,IL-6在术后24 h达到峰值,IL-10在术后8 h达到峰值,且在术后各时点明显高于SK组和S组(P0.01)。在术后2 h,SK组和S组的IL-6和IL-10水平差异无统计学意义(P0.05),但术后8、24、48 h,SK组的IL-6、IL-10水平均低于S组(P0.05)。结论舒芬太尼联合氯胺酮应用于患者自控静脉镇痛,效果确切,能有效抑制患者术后48 h内IL-6、IL-10水平的升高,具有良好的免疫保护和控制应激反应的作用。
[Abstract]:Objective to observe the effect of sufentanil combined with ketamine on postoperative patient-controlled intravenous analgesia and its effect on serum IL-6 and IL-10. Methods 60 patients undergoing epigastric operation were randomly divided into group S (group S) and group C (n = 20). Patients in each group were given patient-controlled intravenous analgesia with a load of 5 ml and a background dose of 2 ml / hPCA 2 ml/. The analgesic formula of 30 min.S group: sufentanil 2.5 渭 g/kg was diluted with 0.9% sodium chloride solution to 100ml SK group: sufentanil 2 渭 g / kg, ketamine 2 mg/kg diluted with 0.9% sodium chloride solution to 100ml / c group as control group. Analgesic formula: morphine 1.2 mg/kg diluted to 100ml with 0.9% sodium chloride solution. The pain scores and adverse reactions of VAS were recorded at 48 h after operation. The peripheral venous blood samples were collected for the determination of serum IL-6 and IL-10 levels at 5 hours before anesthesia and 2 minutes and 24 hours after operation. Results the analgesic effect of SK group and S group was better than that of C group, and SK group was superior to S group. There was no significant difference between SK group and S group in the incidence of adverse reactions (P 0.05), which was significantly lower than that in group C (P 0.05). The levels of IL-6 and IL-10 in group C were significantly higher than those in group C at 2: 48 h after operation. The levels of IL-6 and IL-10 in group C increased gradually at 24 h after operation. The peak value was reached at 8 hours after operation. It was significantly higher than that of SK group and S group at each time point after operation (P 0.01). There was no significant difference in the levels of IL-6 and IL-10 between SK group and S group at 2 h after operation (P 0.05), but the level of IL-6 IL-10 in SK group was lower than that in S group (P 0.05). Conclusion Sufentanil combined with ketamine is effective in patient-controlled intravenous analgesia. It can effectively inhibit the increase of IL-6 IL-10 level within 48 hours after operation and has a good immune protection and stress control effect.
【作者单位】：上海交通大学附属第一人民医院松江分院麻醉科;
【分类号】：R614.1

【共引文献】