舒芬太尼术后镇痛对新生儿外周血白细胞介素-6和白细胞介素-10的影响

Effects of postoperative analgesia with sufentanil on IL-6 and IL-10 in peripheral blood of neonates

目的观察舒芬太尼应用于新生儿术后镇痛的临床效果及对新生儿外周血白细胞介素-6（IL-6）和IL-10的影响。方法选择足月新生儿60例,巨结肠根治等手术后根据镇痛方法随机均分成三组：舒芬太尼组（S组,舒芬太尼0.6-0.8μg.kg^-1.d^-1）、芬太尼组（F组,芬太尼6-8μg.kg^-1.d^-1镇痛）和对照组（N组,未用镇痛药）。记录术毕、术后4、8、12、24 h的RR、HR、SpO2、BP、镇痛评分（CRIES评分）及镇痛满意率等;检测术毕、术后12、24 h新生儿外周血IL-6、IL-10含量;并观察术后24 h内恶心、呕吐、呼吸抑制等并发症。结果与术毕时比较,术后8、12、24 h N组CRIES评分明显升高（P〈0.05）,也明显高于S、F组（P〈0.05）。S、F组镇痛满意率明显高于N组（P〈0.05）。术后12 h三组IL-6含量均较术毕升高（P〈0.05或P〈0.01）,但S、F组明显低于N组（P〈0.01）,术后24 h N组IL-6含量仍高于术毕（P〈0.05）;术后24 h S组IL-10含量较术毕升高（P〈0.05）,N组IL-10含量较术毕降低（P〈0.05）,S、F组IL-10含量均高于N组（P〈0.05）。三组之间恶心呕吐、呼吸抑制等并发症的发生率差异无统计学意义。结论舒芬太尼持续静脉输注用于新生儿术后镇痛安全、效果满意,并可减轻手术后的炎性反应。

Objective To evaluate the effects of postoperative analgesia with sufentanil on interleukin-6（IL-6） and IL-10 in peripheral blood of ineonates.Methods Sixty neonates undergoing abdominal surgery were randomly divided into control group（N,received no analgesia）,fentanyl group（F,received continuous intravenous infusion of fentanyl 6-8 μg·kg-1·d-1） and sufentanil group（S,received continuous intravenous infusion of sufentanil 0.6-0.8 μg·kg-1·d-1）,with 20 cases each.RR,HR,SpO2,BP,analogue scales and analgesia satisfaction were evaluated at 0,4,8,12,and 24 h after operation.IL-6 and IL-10 concentrations in peripheral blood were measured at 0,12 and 24 h after operation.Side effects such as nausea,vomiting and respiratory depression were assessed at 24 h after operation as well.Results Compared with those at 0 h after operation,analogue scales in group N at 8,12 and 24 h were significantly higher（P〈0.05）,which were higher than those in groups of S and F（P〈0.05）.Analgesia satisfaction in groups of S and F was higher than that in group N（P〈0.05）.Compared with that at 0 h after operation,IL-6 concentration at 12 h was higher in three groups,while that in groups of S and F was significantly lower than that in group N（P〈0.01）,which in group N at 24 h was higher than that at 0 h.Compared with that at 0 h,IL-10 concentration at 12 h in group S was higher（P〈0.05）,while that in group N was lower（P〈0.05） and IL-10 concentration in groups of S and F was higher than that in group N（P〈0.05）.There were no significant differences in incidence rates of side effects related to analgesia among three groups.Conclusion Postoperative analgesia with intravenous sufentanil 0.6-0.8 μg·kg-1·d-1 in neonates is sufficient with reduced inflammatory response.