烧伤植皮术后双氯芬酸钠的镇痛效果及其对血浆炎症因子水平的影响

Effects of diclofenac sodium on analgesia and serum inflammatory factor levels of burned patients after skin grafting surgery

目的 探讨应用双氯芬酸钠对烧伤植皮术后镇痛的临床疗效以及对血浆炎症因子的影响.方法 将64例烧伤患者随机分为双氯芬酸钠组和盐酸哌替啶组,每组各32例.所有患者均接受常规烧伤植皮术,术后分别予以口服双氯芬酸钠和肌注盐酸哌替啶进行镇痛治疗,并比较两种镇痛方式的临床镇痛疗效、不良反应发生率及其对血浆白细胞介素-4（IL-4）、IL-6、IL-8、IL-10和肿瘤坏死因子（tumor necrosis factor-α,TNF-α）水平的影响.结果 双氯芬酸钠组镇痛作用起效的时间显著快于传统的盐酸哌替啶组,表现为镇痛开始后1、2和4h视觉模拟评分（VAS）显著低于盐酸哌替啶组（P＜0.05）;但8、12、24和48 h两组的VAS评分比较差异无统计学意义（P＞0.05）.两种镇痛方式对IL-4水平并无影响（P＞0.05）,双氯芬酸钠组IL-6、IL-10和TNF-α水平仅在12 h和48 h时低于盐酸哌替啶组（P＜0.05）,而IL-8水平则在8、12、24、48 h时间点上均低于盐酸哌替啶组（P＜0.05）.观察期内两组患者呼吸抑制、头晕、消化道异常、皮肤瘙痒、尿潴留等情况的发生率比较差异无统计学意义（P＞0.05）;而盐酸哌替啶组出现恶心、呕吐、嗜睡发生率略高于双氯芬酸钠组（P＜0.05）.结论 双氯芬酸钠对烧伤植皮术后患者有较为良好的镇痛疗效,并能有效改善烧伤患者的血浆炎症因子水平.

Objective To explore the effects of diclofenac sodium on analgesia and serum inflammatory factor levels of burned patients after skin grafting surgery.Methods A total of sixty-four burned patients in our hospital were enrolled in the present study and were randomly divided into two groups：diclofenac sodium group and pethidine group,with 32 cases in each group.All patients were given traditional skin grafting surgery after burned,and they were given different methods to analgesia,diclofenac sodium or pethidine.The clinical effects of analgesia,adverse events and serum levels of inflammatory parameters,including interleukin-4,6,8,10 （IL-4,6,8,10） and tumor necrosis factor-α （TNF-α）,were assessed and compared between the two groups.Results Onset time of analgesic effect of diclofenac sodium was significantly faster than pethidine group.The VAS score at 1,2and 4 h was significantly lower than that in the pethidine group （P ＜ 0.05）,while no statistically significant difference was found in VAS score at 8,12,24 and 48 h between the groups（P ＞0.05）.No effect was shown on the level of IL-4 （P ＞ 0.05）,and the level of IL-6 IL-10 and TNF-α in diclofenac sodium group only showed significant lower level than those in the pethidine group at 12 h and 48 h （P ＜ 0.05）.IL-8 levels of the pethidine group were higher than that in the diclofenac sodium group at 8,12,24,48 h time points（P ＜ 0.05）.Further,there was no significant difference on the potential side effects between the groups,such as respiratory depression,dizziness,gastrointestinal abnormalities,pruritus,urinary retention（P ＞0.05） ; whereas,the incidence of nausea and vomiting,drowsiness in the traditional meperidine analgesia group was found slightly higher than that of diclofenac sodium group（P ＜ 0.05）.Conclusion Diclofenac sodium treatment on burned patients after plastic surgery shows promising clinical effects of analgesia,and low serum inflammatory factor levels.