曲马朵超前镇痛对卵巢癌根治术后患者应激反应的影响

Effects of preemptive analgesia with tramadol on stress reaction in patients with ovarian cancer after radical resection

目的：研究曲马朵超前镇痛对卵巢癌根治术患者应激反应的影响。方法将80例择期全麻下行卵巢癌根治术的患者按照计算机随机生成的对照表分成观察组和对照组，每组各40例，观察组患者在麻醉诱导后链接 PECA 泵入曲马朵进行超前镇痛，对照组则在术后以同样的条件泵入曲马朵。患者清醒后均采用苏芬太尼静脉自控镇痛。分别于麻醉前、术后6 h、12 h、24 h 放射免疫法测定测定皮质醇（COR）、促肾上腺皮质激素（ACTH）和血管紧张素Ⅱ，免疫比浊法测定 C 反应蛋白（CRP）的血液浓度，记录患者术后2 h、6 h、12 h、24 h、48 h 的 VAS 评分和48 h 内的不良反应情况。结果术前两组患者 COR、ACTH、ATⅡ、CRP 浓度差异无统计学意义（P ＞0．05），术后各时间点 COR[由术前（208．5±31．6）ng／mL 升至（446．3±19．8）ng／mL）、ACTH[由术前（35．7±8．2）pg／mL 升至（63．5±9．1）pg／mL]、ATⅡ[由术前（46．8±10．9）pg／mL 升至（75．9±12．5）pg／mL]、CRP 浓度[由术前（3．9±0．7）mg／mL 升至（40．5±2．9）mg／mL]均明显高于术前（P ＜0．05），观察组 COR[（446．3±19．8）ng／mL 比（570．8±67．2）ng／mL]、ACTH [（63．5±9．1）pg／mL 比（85．2±12．5）pg／mL）]、ATⅡ[（75．9±12．5）pg／mL 比（108．5±18．1）pg／mL]、CRP 浓度[（40．5±2．9）mg／mL 比（51．8±8．5）mg／mL）]明显低于对照组（P ＜0．05）；术后2 h 观察组休息（2．4±0．7）分和咳嗽（3．4±1．0）分的 VAS 评分显著低于对照组（t ＝5．812，P ＝0．017；t ＝14．606，P ＝0．044）；休息时，其他时间点两组的 VAS 评分差异无统计学意义（均 P ＞0．05）；咳嗽时，6 h[（2．5±0．6）分比（3．1±0．8）分]和12 h 时间点[（2．1±0．6）分比（2．9±0．4）分]两组差异有统计学意义（t ＝13．406，P ＝0．012；t ＝12．625，P ＝0．025），其他时间点差异无统计学意义（均 P ＞0．05）。结论曲马朵超前镇痛联合苏芬太尼术后镇痛能有效减轻卵巢癌根治术患者术后疼痛和应激反应，不良反应少，是一种安全有效的镇痛方法。

Objective To study the effect of preemptive analgesia with tramadol on ovarian cancer patients with stress reaction.Methods 80 cases with ovarian cancer undergoing elective surgery under general anesthesia were divided into the observation group and the control group according to the computer randomly generated control table,40 cases in each group.Patients in the observation group with PECA were pumped into tramadol after anesthesia induction,while the control group was in the same conditions of pumping tramadol after operation.Patients were all treated with intravenous patient -controlled analgesia with sufentanil after waking up.The blood concentrations of cortisol （COR）,adrenal cortical hormone （ACTH）,angiotensin Ⅱ （AT Ⅱ）were determined by radioimmunoassay, and the blood concentrations C reactive protein （CRP）was determined by immune turbidity method.The adverse reactions and the VAS score of patients after 2h,6h,12h,24h,48h were recorded.Results The COR,ACTH,AT Ⅱ, CRP concentrations of the two groups had no significant differences （all P 〉0.05）before operation.After each time point,COR[（208.5 ±31.6）ng/mL vs （446.3 ±19.8）ng/mL],ACTH[（35.7 ±8.2）pg/mL vs （63.5 ±9.1）pg/mL],AT Ⅱ[（46.8 ±10.9）pg/mL vs （75.9 ±12.5）pg/mL],CRP[（3.9 ±0.7）mg/mL vs （40.5 ±2.9）mg/mL] concentrations were significantly higher than those of pre -operation （all P 〈0.05 ）;The concentration of COR [（446.3 ±19.8）ng/mL vs （570.8 ±67.2）ng/mL],ACTH （63.5 ±9.1）pg/mL vs （85.2 ±12.5）pg/mL）,AT Ⅱ[（75.9 ±12.5）pg/mL vs （108.5 ±18.1）pg/mL]and CRP[（40.5 ±2.9）mg/mL vs （51.8 ±8.5）mg/mL]in theobservation group was significantly lower than those in the control group （all P 〈0.05）;After operation,the VAS scores of rest （2.4 ±0.7）and cough （3.4 ±1.0）in the observation group were significantly lower than those in the control group in 2h （t =5.812,P =0.017;t =14.606,P =0.044）;At rest,the other time point of the two groups of VAS scores had no significant difference （P 〉0.05）;At the time of coughing,the two groups were significantly differ-ent only at the 6h[（2.5 ±0.6）vs （3.1 ±0.8）]and 12h[（2.1 ±0.6）vs （2.9 ±0.4）]time point （t =13.406, P =0.012;t =12.625,P =0.025）.Conclusion Preemptive analgesia with tramadol and sufentanil for postoperative analgesia can effectively reduce the radical resection of postoperative pain and the stress reaction after surgery.It is a safe and effective analgesic method.