氯诺昔康与吗啡术后镇痛对胃肠肿瘤手术患者代谢调理的比较

A comparison of the metabolic effect of postoperative analgesia with Iornoxicam and morphine or morphine on patients undergoing gastrointestinal carcinoma operation

目的比较联合应用吗啡和氯诺昔康与单纯应用吗啡进行术后镇痛对胃肠手术患者蛋白质代谢的调理作用。方法选择胃肠道肿瘤根治术患者100例，随机分为2组。每组50例：A组为氯诺昔康联合吗啡镇痛组；B组为吗啡镇痛组。两组患者均在术后3d内禁食并自外周静脉给予营养支持。测定并比较两组患者术后3d的视觉模拟评分（VAS）、体温和氮平衡，以及两组患者术前、术后第1天、第3天的白介素．6（IL-6）、肿瘤坏死因子α（TNF-α）、皮质醇（Cor）和肾上腺素（E）水平。结果两组术后24、48和72h静止与活动时的VAS分值差异无统计学意义（P〉0．05）。术后3d两组患者的体温均较术前的增高（P〈0．05），B组术后第1、3天的体温明显高于A组（P〈0．05）。术后3d两组患者均出现负氮平衡，第1天的负值最高，与第3天比较差异有统计学意义（P〈0．05）；B组术后3d的负氮平衡值均明显高于A组（P〈0．05）。两组患者术后第1、3天的血浆Cor和E水平均较术前明显增高（P〈0．05），术后第3天则较术后第1天显著降低（P〈0．05）；两组间差异无统计学意义（P〉0．05）。B组患者术后第1、3天的TNF-α及IL-6值明显高于A组（P〈0．05），且较术前显著增高（P〈0．05）。结论术后联合应用吗啡与氯诺昔康镇痛与单纯应用吗啡比较，镇痛作用相近，但前者能产生更好的代谢调理作用。

Objective To compare the metabolic effect of postoperative analgesia with lornoxicam/morphine or morphine on patients undergoing gastrointestinal carcinoma operation. Methods One hundred patients, undergone gastrointestinal carcinoma operations, were randomly assigned into two groups： group A received postoperative analgesia with lomoxicam/morphine and Group B with morphine alone. Parenteral nutrition with limited nitrogen resource was given to both groups. Visual analog scale （VAS）, temperature and postoperative nitrogen balance were monitored postoperatively. The concentration of plasma cortisol , epinephrine, tumour necrosis factor-α （TNF-α） and interleukin-6 （IL-6） were measured preoperatively and day 1, 3 postoperatively. Results VAS of two groups at 24 th, 48 th, 72 th after operation were similar （P〉0.05）. The temperature of two groups on the third postoperative day increased as compared to that before operation, and the temperature of group B on 1st and 3rd postoperative day [（37.8±0.6）, （37.5±0.8）℃] were significantly higher than those of group A[（37.3±0.5）℃, （37.0±0.8）℃] （P〈0.05）. Nitrogen balance within 3 days after operation were -7.5±3.2, -5.2±4.2, -3.1±1.2 in group A and -16.7±7.3, -10.5±6.1, -9.1±2.1 in group B （P〈 0.05）. The post-operative plasma concentrations of cortisol and epinephrine increased significantly in both groups as compared to those examined preoperatively （P〈0.05）, but there was no significant difference between the two groups. However, the plasma concentrations of TNF-α and IL-6 in group B were significantly higher than those in group A （P〈0.05）. Conclusions Postoperative analgesia with lomoxicam/morphine or morphine is able to produce an adequate postoperative analgesia to patients undergoing gastrointestinal carcinoma operation. Lomoxicam and morphine analyesia possesses a better metabolic intervention in decreasing the protein matabolism and improving the nitrogen balance.