高乌甲素超前镇痛对术后疼痛及患者血清IL-2和IL-6水平的影响

Preemptive analgesic effects of lappaconitine on postoperative pain and serum IL-2 and IL-6

目的研究以高乌甲素行超前镇痛对术后疼痛及患者围手术期血清白细胞介素2(IL-2)和IL-6水平的影响。方法 63例子宫肌瘤患者,硬膜外麻醉下行经腹子宫全切术,随机分为三组,每组21例。A组,术前30min缓慢静注高乌甲素4mg;B组术毕缓慢静注高乌甲素4mg,C组不施行超前镇痛。术后静息时患者主诉疼痛难忍,肌注曲吗多镇痛(100mg/次)。分别于术前、术毕、术后12h和术后24h抽取外周静脉血,采用放射免疫分析法测定血清IL-2和IL-6的浓度,并于术后VAS疼痛评分。结果 A组的VAS评分在术后各时间点均显著低于C组,B组在术后4hVAS疼痛评分显著低于C组(P<0.01)。C组术后24h内用镇痛药的患者占33.33%,显著高于A、B组(P<0.05)。A组IL-2和IL-6的浓度波动均不明显;与A组比较,C、B组术后IL-2浓度显著降低,IL-6浓度显著升高。结论高乌甲素行超前镇痛能够减轻下腹部手术的术后疼痛,减少术后镇痛药的应用,能有效的抑制应激反应,减轻术后免疫抑制。

Objective To study the preemptive analgesia effects of lappaconitine on postoperative pain and serum interleukin（IL）-2 and IL-6.Methods Sixty-three patients with hysteromyoma undergoing selective hysteromyomectomy were randomly assigned to three groups with 21 cases each.The patients in group A received lappaconitine 4 mg at 30 min before skin incision,those in group B received lappaconitine 4 mg at the end of operation,and those in group C were not given preemptive analgesia as the controls.Tramadol 100 mg was intramuscularly injected if necessary after operation.Serum levels of IL-2 and IL-6 were measured by radioimmunoassay.Results VAS after operation was significantly lower in group A than that in groups of B and C.VAS was lower in group B than that in group C at 4 h postoperatively（P0.01）.There were 33.3 percent of patients in group C received postoperative analgesia,which was significantly higher than that in groups of A and B.Compared to group A,serum IL-2 was decreased and IL-6 increased significantly after operation in groups of B and C.Conclusion Preemptive analgesia with lappaconitine can effective attenuate postoperative pain and reduce stress response to surgical injury.