地佐辛用于妇科恶性肿瘤手术病人术后镇痛的效果及安全性观察

CLINICAL EFFECT AND SAFETY OF DEZOCINE IN THE POSTOPERATIVE ANALGESIA AFTER THE GYNECOLOGICAL SURGERY OF MALIGNANT TUMOR

目的:探讨地佐辛用于妇科恶性肿瘤手术病人术后镇痛的临床效果及安全性。方法:临床纳入妇科恶性肿瘤手术病人70例,根据术后静脉自控镇痛(PICA)给药的不同分为研究组与对照组。研究组给予地佐辛,对照组给予芬太尼。采用疼痛视觉模拟评分法(VAS)比较两组病人术前(T0)、术后即刻(T1)、术后2h(T2)、术后6h(T3)、术后24h(T4)、术后48h(T5)时疼痛情况。分别在T0、T1、T4、T5时采集两组病人静脉血:(1)对血浆肾上腺素(E)、去甲肾上腺素(NE)及多巴胺(DOP)水平进行检测;(2)对CD3+、CD4+、CD8+、CD4+/CD8+、NK细胞活性进行检测。另外,观察两组病人术后药物不良反应情况。结果:(1)T0、T1时两组病人VAS评分差异无显著性(P>0.05)。研究组T2、T3、T4时VAS评分均明显低于对照组,差异有显著性(P<0.05);(2)两组病人T0、T1时E、NE、DOP水平差异无显著性(P>0.05)。研究组T4、T5时E、NE、DOP水平明显低于对照组,差异有显著性(P<0.05);(3)两组病人T0、T1、T4时CD3+、CD4+、CD8+、CD4+/CD8+、NK细胞活性等指标差异均无显著性(P>0.05)。研究组T5时CD3+、CD4+、NK细胞活性均明显高于对照组,差异均有显著性(P<0.05);(4)两组病人恶心、呕吐、低血压、呼吸抑制等不良反应发生率差异均无显著性(P>0.05)。结论:地佐辛用于妇科恶性肿瘤手术病人术后镇痛相比芬太尼具有更好的镇痛效果,病人术后应激反应较轻,细胞免疫功能恢复较快,且不良反应较少,值得推广。

Objective：To observe the clinical effect and safety of Dezocine in the postoperative analgesia after the gynecological surgery of malignant tumor. Methods： 70patients of adopting the gyne- cological surgery of malignant tumor were selected. The subjects were divided into study group and control group according to different PICA drugs. The study group took Dezocine and control group took Fentanyl. The VAS score before surgery （ TO ） , after surgery （ T1 ） , after 2 h of surgery （ T2 ） , after 6 h of surgery（ T3 ）, after 24 h of surgery （ T4 ）, after 48 h of surgery （ T5 ） was compared. At TO, T1, T4 and TS, the venous blood was collected ： （ 1 ） the level of E, NE and DOP was detected ; （2） the cell activity of CD3 ＋, CD4 ＋, CD8 ＋, CD4 ＋/CD8 ＋ and NK was detected. The adverse reactions were observed. Result： （1）at TO and T1, the VAS score for two groups was not significantly different（ P〉0.05 ）;at T2 ,T3 and T4 ,the VAS score for study group was lower than control group（ P〈0.05 ） ;（2）at TO and T1, the level of E, NE, DOP for two groups was not significantly different（ P〉0.05 ） ;at T4 and T5, the level of E, NE, DOP for study group was lower than control group（ P〈0.05 ） ;（ 3 ）at TO, T1 and T4, the cell activity of CD3＋ ,CIM＋ ,CD8＋ ,CD4＋/CD8＋ and NK for two groups was not significantly different （ P〉0.05 ） ; at T5, the cell activity of CD3 ＋, CD4 ＋ and NK for study group was higher than control group（P〈0.05 ）;the incidence rate of adverse reactions like nausea, emesis, hypotension, respiratory depression for two groups was not significantly different（ P〉0.05 ）. Conclusion：After the gynecological surgery of malignant tumor, Dezocine has a better analgesia effect than Fentanyl, has milder stress response, faster recovery of cellular immune function and fewer adverse reactions. It is worthy of promo- tion.