氯胺酮联合利多卡因超前镇痛对宫颈癌患者术后疼痛、炎症、应激反应的影响

Effects of ketamine combined with lidocaine for preemptive analgesia on postoperative pain,inflammatory response and stress response in patients with cervical cancer

目的:探讨氯胺酮联合利多卡因超前镇痛对宫颈癌患者术后疼痛、炎症、应激反应的影响。方法:选取2016年7月~2017年5月在本院接受根治性手术治疗的宫颈癌患者68例,回顾术后镇痛方案并分为常规镇痛组37例、氯胺酮组31例。常规镇痛组患者接受利多卡因超前镇痛、氯胺酮组患者接受氯胺酮联合利多卡因超前镇痛。对比两组患者术前(T0)、术后苏醒即刻(T1)、术后24h(T2)血清中疼痛介质、炎症因子、应激激素含量的差异。结果:T0时,两组患者血清中疼痛介质、炎症因子、应激激素含量的差异无统计学意义。T1、T2时,氯胺酮组患者血清中疼痛介质SP、NPY的含量低于常规镇痛组;炎症因子IL-1β、IL-6、IL-8的含量低于常规镇痛组;应激激素AngⅠ、AngⅡ、NE的含量低于常规镇痛组。结论:宫颈癌患者接受氯胺酮联合利多卡因超前镇痛,可有效抑制患者术后早期疼痛介质分泌,减轻全身炎症及应激反应。

Objective：To investigate the effects of ketamine combined with lidocaine for preemptive analgesia on postoperative pain,inflammatory response and stress response in patients with cervical cancer.Methods：68 patients with cervical cancer who received radical operation in the hospital between July 2016 and May 2017 were divided into routine analgesia group（n=37）and ketamine group（n=31）according to the postoperative analgesic solution.Routine analgesia group received lidocaine for preemptive analgesia and ketamine group received ketamine combined with lidocaine for preemptive analgesia.The differences in serum levels of pain mediators,inflammatory factors and stress hormones were compared between the two groups before surgery（T0）,immediately after postoperative recovery（T1）and 24 hafter surgery（T2）.Results：At T0,there was no statistically significant difference in serum levels of pain mediators,inflammatory factors and stress hormones between the two groups.At T1 and T2,serum pain mediators SP and NPY levels of ketamine group were lower than those of routine analgesia group;inflammatory factors IL-1β,IL-6 and IL-8 levels were lower than those of routine analgesia group;stress hormones AngⅠ,AngⅡ and NE levels were lower than those of routine analgesia group.Conclusion：Ketamine combined with lidocaine for preemptive analgesia can effectively suppress the early postoperative pain mediator secretion and relieve the systemic inflammatory response and stress response in patients with cervical cancer.