地佐辛对乳腺癌患者术后疼痛及炎性因子的影响

Effects of Dezocine on Postoperative Pain and Inflammatory Factor in Breast Cancer Patients

目的:评价地佐辛对乳腺癌患者术后疼痛、炎性因子水平的影响及安全性。方法:选取行乳腺癌根治术患者100例,按随机数字表法分为对照组和观察组,各50例。两组患者均行气管插管全凭静脉全身麻醉,采用舒芬太尼0.3μg/kg,ivgtt,麻醉诱导。对照组患者术毕前20 min输注舒芬太尼10μg;观察组患者术毕前20 min静脉输注地佐辛2.5 mg。记录两组患者术后1、8、12、24、48 h视觉模拟评分(VAS)及术前、术后1、2、3、5 d的C反应蛋白(CRP)、白细胞介素(IL)-6、肿瘤细胞坏死因子(TNF)-α水平,并观察两组患者不良反应发生情况。结果:观察组患者术后8、12、24、48 h的VAS评分显著低于对照组,差异有统计学意义(P<0.05);术后1 d两组患者血清CRP、IL-6、TNF-α水平显著升高,且对照组明显高于观察组,差异有统计学意义(P<0.05);观察组和对照组患者血清CRP、IL-6、TNF-α水平分别于术后3、5 d与术前比较,差异无统计学意义(P>0.05)。观察组患者恶心、呕吐、皮肤瘙痒的发生率显著低于对照组,麻醉苏醒延迟发生率则高于对照组,差异均有统计学意义(P<0.05)。结论:地佐辛较舒芬太尼更能有效减轻乳腺癌患者术后疼痛,降低患者术后炎症反应,且胃肠道反应较低,耐受性好,但患者容易发生麻醉苏醒延迟,应对患者加强监护。

OBJECTIVE：To evaluate the effects of dezocine on postoperative pain and the levels of inflammatory factor in breast cancer patients. METHODS：100 breast cancer surgery patients were selected and randomly divided into control group and observation group with 50 cases in each group. All patients received tracheal total intravenous anesthesia intubation,sufentanil 0.3μg/kg,ivgtt,for anesthesia induction. Control group were infused with sufentanil 10 μg 20 min before the end of surgery. Observation group was given dezocine 2.5 mg intravenously 20 min before the end of surgery. The visual analogue scale（VAS）were recorded in 2 groups 1,8,12,24,48 h after operation;the levels of CRP,IL-6 and TNF-α were recorded before surgery and 1,2,3,5 d after surgery. The occurrence of ADR was observed in 2 groups. RESULTS：The VAS scores of observation group were significantly lower than that of control group 8,12,24,48 h after surgery,with statistical significance（P0.05）. The levels of CRP,IL-6 and TNF-α in 2 groups increased significantly 1 d after surgery,and the control group was significantly higher than the observation group,with statistical significance（P0.05）. There was no statistical significance in the levels of CRP,IL-6 and TNF-α in 2 groups between 3 and 5 d after surgery and before operation（P0.05）. The incidence of nausea,vomiting,urinary retention,pruritus in observation group was significantly lower than control group,whereas the incidence of anesthesia delay was higher than control group,with statistical significance（P0.05）. CONCLUSIONS：Dezocine in better than fentanyl to effectively relieve postoperative pain in patients with breast cancer and reduce postoperative inflammation,and result in mild gastrointestinal reactions and good tolerance;but the patients are prone to anesthesia delay,intensive care should be strengthened.