芬太尼镇痛对严重烧伤患者休克期应激反应和免疫功能的影响

Effect of Patient Controlled Intravenous Analgesia with Fentanyl during Shock Stage on Stress Reaction and Immune Function in Patients with Severe Burn

目的探讨严重烧伤患者休克期芬太尼静脉自控镇痛的安全性、有效性,及其对应激反应和免疫功能的影响。方法 40例严重烧伤患者于伤后24 h内入院,随机分为传统镇痛(CAT)组、静脉输注芬太尼自控镇痛(PCIA)组,每组20例。在积极抗休克的同时,CAT组根据需要肌肉注射哌替啶50 mg和异丙嗪25 mg。PCIA组给予芬太尼镇痛,配方:芬太尼10μg/mL+氟哌利多50μg/mL,负荷剂量3 mL,背景输注剂量2 mL/h。对镇痛开始前、后两组患者疼痛程度和镇静状态通过视觉模拟标尺(VAS)进行评分,并观察有无恶心、呕吐、幻觉、呼吸抑制等不良反应;检测镇痛前、后血浆应激激素(ACTH、Cor、E和NE)以及细胞因子(IL-1、IL-6和TNF-α)的浓度。结果 PCIA组镇痛效果明显优于CAT组(P<0.01)。两组均未出现明显的恶心、呕吐、幻觉及呼吸抑制等不良反应;PCIA组镇痛开始后血浆中应激激素及细胞因子的水平大部分明显降低(P<0.05),与CAT组各时点比较差异均有统计学意义(均P<0.01)。结论严重烧伤患者采用芬太尼静脉自控镇痛能明显降低机体的应激反应,抑制炎性细胞因子的释放,发挥免疫调节作用。

Objective To investigate the efficacy and safety of patient controlled intravenous analges（PCIA）combined with fentanyl for patients in burn shock stage, and the influence on cytokine balance and stress reaction. Methods Forty patients with severe burn and hospitalized with 24 h after injury were randomly divided into two groups（n= 20 in each group）：conven tional analgesia therapy group（CAT group）,and patient controlled intravenous fentanyl analgesia group（PCIA group）. In CAT group,the patients received intramuscular injection of pethidine 50 mg and phenergan 25 mg when patients complained of pain. In PCIA group,patients received intravenous infusion with a mixture of fentanyl 10 μg/mL ＋ droperidol 50 μg/mL（loading dose of 3 mI.,with background infusion of 2 mL/h）. The VAS score and side effects of analgesics were observed after anal gesia, serum stress hormone（ ACTH, Cor, E, NE） and cytokines （ IL-1, II.-6, TNF a） were measured 1,8,24,48 h after analgesi a. Results VAS scores in PCIA groups were significantly lower than those before analgesia and CAT group（P〈0.01）. No sig nificant difference in side effects was found between two groups. The stress hormone and cytokines were inhibited more effi ciently in PCIA group 1,8,24,48 h after analgesia（P〈0.05） ;and the serum levels of stress hormone and cytokines were signif icantly lower in PCIA group than in CAT group（P〈0.01）. Conclusion PCIA with fentanyl during shock stage in patients with severe burn gives efficient and safe pain relief,and can alleviate the stress reaction and suppress cytokine releasing.