地佐辛联合芬太尼对冠心病患者非心脏手术术后镇痛及心肌损伤的影响

Effects of lipid microspheres dezocine combined with fentanyl injection on postoperative pain and myocardial injury in patients with coronary heart disease undergoing noncardiac surgery

目的探讨地佐辛联合芬太尼对冠心病患者非心脏手术术后镇痛及心肌损伤的影响。方法将40例心功能Ⅰ或Ⅱ级择期行上腹部手术的冠心病患者随机分为地佐辛组（F组）与对照组（C组）,每组各20例。分别于气管插管后（切皮前15分钟）静脉注射地佐辛3 mg/kg（F组）和安慰剂（C组）各10 ml。两组患者术后均行静脉自控镇痛（PCIA）。连续监测患者血流动力学及心电图变化,记录患者苏醒后、术后4、8、12、24、48小时视觉模拟评分（VAS）,在术前（T1）、手术2小时（T2）、术毕（T3）及术后24小时（T4）检测肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）及心肌肌钙蛋白I（cTnI）浓度。结果 F组患者于苏醒后及术后4、8小时VAS评分明显低于C组（P〈0.05）;F组患者在T2-T3时点血清TNF-α含量低于C组（P〈0.05）;在T2-T4时点,F组血清IL-6含量及cTnI浓度低于C组,血清IL-10含量高于C组（P〈0.05）。结论地佐辛联合芬太尼能够提高冠心病患者非心脏手术术后镇痛的效果,减轻心肌损伤。

Objective To investigate the analgesic effect and impact on myocardial injury of the lipid microspheres dezocine combined injection in patients with coronary heart disease undergoing noncardiac surgery. Method 40 patients with coronary artery disease and heart function scale of 1 or 2 scheduled for epigastric operation were randomly divided into two groups of F（dezocine combined 3 mg/kg） and C（fat emulsion 10 ml） with 20 cases each. The drugs were intravenously injected 15 minutes before skin incision. Hemodynamics and ECG were monitored continuously. The values of VAS scores were recorded at after awaking and at 4 hours, 8 hours, 12 hours, 24 hours, 48 hours after operation. Blood samples were taken for determination of serum levels of TNF-α, IL-6, IL-10 and c Tn I before operation（T1）, at 2 hours of operation（T2）, immediately after the end of operation（T3） and 24 hours after operation（T4）. Result The VAS scores was lower in group F than in group C at after awaking and 4 hours, 8 hours after operation（P〈0.05）. TNF-α was decreased at T2 - T3 in group F than that in group C（P〈0.05）. The value of IL-6 and the level of cTnI were decreased and the value of IL-10 was increased at T2 - T4 in group F than those in group C（P〈0.05）. Conclusion Dezocine combined with fentanyl injection could improve the analgesia effects, alleviate postoperative myocardial injury in patients with coronary heart disease undergoing noncardiac surgery. Suppression of inflammatory response may contribute to the mechanism.