羟考酮静脉自控镇痛对腹腔镜下宫颈癌根治术后患者相关指标的影响

Effects of Oxycodone Patient-controlled Intravenous Analgesia on Related Indicators of Patients after Laparoscopic Radical Resection of Cervical Cancer

目的:探讨羟考酮静脉自控镇痛(PCIA)对腹腔镜下宫颈癌根治术后患者相关指标的影响。方法:选择2016年2月-2017年5月我院择期行腹腔镜下宫颈癌根治术的患者120例,按随机数字表法分为对照组(60例)和观察组(60例)。接受腹腔镜下宫颈癌根治术后,对照组患者给予枸橼酸芬太尼注射液20μg/kg,加入0.9%氯化钠注射液至150 mL,输注速率3.5 mL/h,首次剂量4 mL,PCIA剂量2 mL,自控锁定时间10 min;观察组患者给予盐酸羟考酮注射液0.4 mg/kg,加入0.9%氯化钠注射液至150mL,输注速率3.5 mL/h,首次剂量4 mL,PCIA剂量2 mL,自控锁定时间10 min。观察两组患者术后12、24、48 h的疼痛视觉模拟评分法(VAS)评分,术前30 min及术后24、48、72 h的血清干扰素γ(IFN-γ)、白细胞介素10(IL-10)、自然杀伤(NK)细胞、CD3+、CD4+、CD8+水平及不良反应发生情况。结果:两组均无患者脱落。两组患者术后24、48 h的VAS评分均显著低于同组术后12 h,差异均有统计学意义(P<0.05);而两组间比较差异均无统计学意义(P>0.05)。术前30 min,两组患者IFN-γ、IL-10、NK细胞、CD3+、CD4+、CD8+水平比较,差异均无统计学意义(P>0.05)。术后24、48、72 h,两组患者IFN-γ、IL-10水平均显著高于同组术前30 min,且均随时间延长逐渐降低,但观察组显著低于对照组,差异均有统计学意义(P<0.05);两组患者NK细胞、CD3+、CD4+、CD8+水平均显著低于同组术前30 min,且均随时间延长逐渐升高,但观察组术后24、48 h上述指标显著高于对照组,差异均有统计学意义(P<0.05)。观察组患者不良反应发生率(8.33%)显著低于对照组(20.00%),差异有统计学意义(P<0.05)。结论:羟考酮PCIA用于腹腔镜下宫颈癌根治术后的镇痛效果较好,可降低机体炎症因子水平,改善免疫功能,且安全性较高。

OBJECTIVE：To investigate the effects of oxycodone patient-controlled intravenous analgesia（PCIA） on related indicators of patients after laparoscopic radical resection of cervical cancer. METHODS：A total of 120 patients underwent selective laparoscopic radical resection of cervical cancer were selected from our hospital during Feb. 2016-May 2017. They were divided into control group（60 cases）and observation group（60 cases）according to random number table. After laparoscopic radical resection of cervical cancer,control group was given Fentanyl citrate injection 20 μg/kg,added into 0.9% Sodium chloride injection to 150 mL,at 3.5 mL/h with initial dose of 4 mL,PCIA dose of 2 mL and self-control locking time of 10 min. Observation group was given Oxycodone hydrochloride injection 0.4 mg/kg,added into 0.9% Sodium chloride injection to 150 mL,at 3.5 mL/h with initial dose of4 mL,PCIA dose of 2 mL and self-control locking time of 10 min. VAS scores 12,24,48 h after surgery,serum levels of IFN-γ,IL-10,NK cells,CD3＋,CD4＋and CD8＋30 min before surgery and 24,48,72 h after surgery,the occurrence of ADR were observed in2 groups. RESULTS：All patients of both groups completed the study. VAS scores of 2 groups 24,48 h after surgery were significantly lower than 12 h after surgery,with statistical significance（P〈0.05）. There was no statistical significance between 2 groups（P〉0.05）. Thirty min before surgery,there was no statistical significance in the levels of IFN-γ,IL-10,NK cells,CD3＋,CD4＋or CD8＋between 2 groups（P〈0.05）;24,48,72 h after surgery,the levels of IFN-γ and IL-10 in 2 groups were significantly higher than 30 min before surgery,and the observation group was lower than the control group,with statistical significance（P〈0.05）;the levels of NK cells,CD3＋,CD4＋and CD8＋in 2 groups were significantly lower than 30 min before surgery,but increased gradually as time;the indexes above of observation group was significantly higher than the control group 24,48 h after surgery,with statistical significance（P〈0.05）. The incidence of ADR in observation group（8.33%） was significantly lower than control group（20.00%）,with statistical significance（P〈0.05）. CONCLUSIONS：Oxycodone PCIA shows good analgesic effect after laparoscopic radical resection of cervical cancer and can effectively decrease the levels of serum inflammatory factors and improve immune function with good safety.