非阿片药物复合推管内麻醉在大肠癌手术中使用的可行性研究

Feasibility analysis on use of other analgesics substituting opioid drugs during operation in patients with colorectal cancer

目的分析非阿片药物复合推管内麻醉在大肠癌手术中使用的可能性。方法将75例各类(腔镜和开腹)大肠癌手术的患者分为阿片药物麻醉(A组)、阿片药物复合椎管内麻醉(H组)、非阿片药物复合椎管内麻醉(F组)3组。记录不同阶段的熵指数、心率(HR)、平均动脉压(MAP)、苏醒时间、拔管时间、患者术前和术后各时间点疼痛的VAS评分、术后肛门排气时间;术后住院时间;并采用ELISA测试血清干扰素-γ(INF-γ)及白细胞介素(IL)-6、IL-10的水平。结果 3组患者麻醉时的熵指数、HR及MAP比较差异无统计学意义(P>0.05);F组患者的苏醒时间、拔管时间与A、H组比较,差异有统计学意义(P<0.05);H、F组患者的VAS评分显著低于A组(P<0.05),但H、F组比较差异无统计学意义(P>0.05);3组患者术后肛门排气时间与住院时间比较差异无统计学意义(P>0.05);手术3d后,H、F组患者的IFN-γ水平高于A组(P<0.05),但H、F组比较差异无统计学意义(P>0.05);手术1d后,A组患者的IL-6水平高于H、F组(P<0.05),但H、F组比较差异无统计学意义(P>0.05);手术完毕时,A组患者的IL-10水平明显高于H、F组(P<0.05),但H、F组比较差异无统计学意义(P>0.05)。结论基于样本分析结果,非阿片药物复合椎管内麻醉对大肠癌手术患者可能有更好的保护作用,对患者的术后恢复有更好的促进作用。

Objective To analyze the possibility of using other analgesic drugs substituting opioid drugs during operation in the patients with colorectal cancer. Methods Totally 75 patients with various operations（laparoscopy and laparotomy） were divided into the opioid drugs anesthesia group （A）,opioid drugs combined intravertebral anesthesia group （H） and non-opioid drugs combined intravertebral anesthesia （F）, 25 cases in each group. The entropy index （EI）, heart rate （HR）, mean artery pressure（MAP）, recovery time （RT）,extubation time （ET）, VAS pain scores in different periods were recorded, postoperative anal exhaust time （AET）, postoperative discharge time （DT） were also recorded. In addition, the levels of serum IFN-γ, IL-6 and IL-10 were tested and analyzed by enzyme-linked imrnunosorbent assay （ELISA）. Results There were no significant difference in EI, HR, MAP, AET and DT during anesthesia among the three groups（P〉0.05）. RT and ET had statistically significant difference between the group F with the group A and H （P〈0.05）. The VAS pain scores in different periods in the group H and F were significantly lower than those in the group A, but the difference between the group H and F had no statistical significance （P〉0.05） ;postoperative AET and DT had no statistical difference among the three groups（P〉0.05） ;the IFN-γ level after postoperative 3 d in the group H and F was higher than that in the group A,but the difference between the group H and F had no statistical significance （P〉0.05） ; the IL-6 level on postoperative 1 d in the group A was higher than that in the group H and F（P〈0.05） ,but the difference between the group H and F had no statistical significance （P〉0.05） ;the IL-10 level at the end of operation in the group A was significantly higher than that in the group H and F（P〈0.05） ,but the difference between the group H and F had no statistical significance （P〉0.05）Conclusion According to the results of sample analysis,non-opioid drugs combined intravertebral anesthesia may have a better protective effect in the patients with colorectal cancer and has the promoting effect on postoperative recovery.