经鼻内镜鼻窦术后自控静脉镇痛对血浆白细胞介素-2、肿瘤坏死因子-α的影响

Effect of patient-controlled intravenous analgesia after endoscopic sinus surgery on plasma IL-2 and TNF-α

目的:研究经鼻内镜鼻窦手术后自控静脉镇痛对患者血浆白细胞介素-2(IL-2)、肿瘤坏死因子-α(TNF-α)的影响。方法:选择ASAⅠ～Ⅱ级择期行功能性鼻内镜鼻窦手术的患者40例,随机分为两组,各组20例。试验组为自控静脉镇痛组,对照组为口服药镇痛组。术后8、24、48h随访。分别记录并比较术后各时间点VAS评分,术前术后血压、血氧、心率、呼吸及不良反应发生率。分别于麻醉前、术后8、24、48h抽取外周静脉血检测血清IL-2、TNF-α。结果:试验组镇痛效果满意。48h内各时间点,VAS评分对照组>试验组(P<0.05),血压、血氧、心率、呼吸两组比较差异无显著性(P>0.05),两组术后TNF-α均升高(P<0.05),对照组术后TNF-α升幅较试验组大(P<0.05);与术前相比,对照组术后48h内各时间点血浆IL-2均降低(P<0.05),IL-2试验组术前术后比较差异无显著性(P>0.05)。结论:自控静脉镇痛在经鼻内镜鼻窦手术后取得良好镇痛效果,并且有效的调节细胞因子的平衡,缓解了术后的免疫损伤。

Objective To explore the effect of patient-controlled intravenous analgesia for endoscopic sinus surgery on cytokines IL-2 and TNF-α. Methods 40 ASA Ⅰ -Ⅱ patients undergoing elective endoscopic sinus surgery were randomized to receive patient-controlled intravenous analgesia （experimental group, n = 20） or oral analgesia （control group, n = 20） and followed at hours 8, 24, and 48 after the procedure. The differences of VAS scores, blood pressure and oxygen, heart rate, breathing, and incidence of adverse reactions were compared in the two groups at each time point and serum levels of IL-2 and TNF-α were mearsured. Results Analgesic effect was ideal in the experimental group. VAS score was significant higher in the control group than in the experimental group （P 〈 0.05）. There were no significant differences between the two groups in blood pressure and oxygen, heart rate, and breathing （P 〉 0.05）. TNF-α level in the control group elevated more than that in the experimental group after anesthesia （P 〈 0.05）. IL-2 delined in the control group at three time points （P 〈 0.05） and did not differ significantly in the experimental group. Conclusions Intravenous patient-controlled analgesia after endoscopic sinus surgery has a better effect, effectively regulates the balance of pro/anti-inflamatory cytokines, and relieve postoperative immune injury.