氯诺昔康术后镇痛对神经外科患者内皮素1的影响

Effects of patient-controlled intravenous analgesia with lornoxicam on plasma endothelin-1 in patients after craniotomy

目的观察术后患者静脉自控镇痛(PCIA)对神经外科患者血浆内皮素1(ET-1)的影响。方法120例ASAⅠ或Ⅱ级择期开颅手术患者,随机均分为四组,术后分别接受不同镇痛方法:L组,氯诺昔康16μg.kg-1.h-1;F组,芬太尼0.2μg.kg-1.h-1;T组,曲马多0.2 mg.kg-1.h-1;D组,未行PCIA。记录术后6、12、24和48 h的静息疼痛视觉模拟评分(VAS)和Ramsay镇静评分。分别于术前、术后6、12及24 h采血,应用放射免疫法检测血浆ET-1的水平。结果术后6、12 h L、F及T组VAS均显著低于D组(P<0.05)。L组和D组术后各时点的Ramsay镇静评分显著低于F组和T组(P<0.05)。L、F及T组患者术后6、12及24 h的血浆ET-1水平显著低于D组(P<0.05)。L组和D组患者术后嗜睡、恶心呕吐等不良反应明显低于F组和T组(P<0.05)。结论氯诺昔康、芬太尼及曲马多PCIA术后镇痛均有利于抑制颅脑外科术后应激导致的血浆ET-1水平增高,氯诺昔康PCIA更适合于神经外科术后镇痛。

Objective To study the effects of patient-controlled intravenous analgesia （PCIA） on plasma endothelin-1（ET-1） of patients underwent craniotomy. Methods One hundred and twenty patients were randomly divided into four groups. The patients in group L were given PCIA with lornoxicam 16μg· kg^-1· h^-1,ingroup F fentanyl 0.2μg· kg^-1· h^-1,in group T tramadol 0.2 mg· kg^-1· h^-1, and in group D without PCIA. The plasma ET-1 levels were detected using radioimmunoassay before anesthesia induction, at 6,12 and 24 h after craniotomy. Results ET-1 levels in group F,L and T were significantly lower than those in group D（P〈0.05） at 6,12 and 24 h after craniotomy. The numbers of nausea, vomiting and dizziness in group L and group D were significantly less than those in group F and group T（P〈0.05）. Conclusion PCIA with lornoxican is a better method in suppressing the increase of plasma ET-1 levels with less side effects in the patients underwent craniotomy.