不同剂量舒芬太尼联合右美托咪定和地佐辛对直肠癌患者术后镇痛效果及血小板活化指标的影响

Effects of different doses of sufentanil combined with dexmedetomidine and dezocine on postoperative analgesia and platelet activation in rectal cancer patients

目的探讨不同剂量舒芬太尼联合右美托咪定和地佐辛对直肠癌患者术后镇痛效果及血小板活化指标的影响。方法将河南大学第一附属医院2015年6月至2017年12月收治的择期行直肠癌根治术的138例患者分为Ⅰ、Ⅱ、Ⅲ组,每组46例。患者术中均予以全身麻醉,术后予以静脉镇痛泵镇痛,Ⅰ、Ⅱ、Ⅲ组患者术后镇痛药物分别为1. 0μg·kg^(-1)舒芬太尼+1. 5μg·kg^(-1)右美托咪定+0. 3 mg·kg^(-1)地佐辛、1. 5μg·kg^(-1)舒芬太尼+1. 5μg·kg^(-1)右美托咪定+0. 3 mg·kg^(-1)地佐辛、2. 0μg·kg^(-1)舒芬太尼+1. 5μg·kg^(-1)右美托咪定+0. 3 mg·kg^(-1)地佐辛。比较3组患者术后1 h(T0)、3 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)疼痛视觉模拟评分(VAS)、Ramsay镇静评分、舒适度评分(BCS);并比较3组患者手术前后氧化损伤、应激反应、血小板活化指标及术后不良反应发生情况。结果 T0、T1、T2、T3、T4时Ⅱ、Ⅲ组患者的VAS评分均显著低于Ⅰ组(P <0. 05),BCS评分高于Ⅰ组(P <0. 05)。T0、T1、T2、T3、T4时Ⅱ、Ⅲ组患者VAS评分及BCS评分比较差异无统计学意义(P> 0. 05)。T0、T1、T2、T3、T4时3组患者Ramsay镇静评分比较差异无统计学意义(P> 0. 05)。术前3组患者血清谷胱甘肽过氧化物酶(GSH-Px)、脂质过氧化物(LPO)、肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)、血栓素A2(TXA2)及血小板颗粒膜蛋白140(GMP140)水平比较差异均无统计学意义(P> 0. 05)。3组患者术后血清GSH-Px水平显著低于术前,LPO、E、NE、Cor、TXA2、GMP140水平显著高于术前(P <0. 05);术后Ⅱ、Ⅲ组患者血清GSH-Px水平显著高于Ⅰ组,LPO、E、NE、Cor、TXA2、GMP140水平显著低于Ⅰ组(P <0. 05);术后Ⅱ、Ⅲ组患者血清GSH-Px、LPO、E、NE、Cor、TXA2、GMP140水平比较差异无统计学意义(P>0. 05)。Ⅰ、Ⅱ、Ⅲ组患者不良反应发生率分别为8. 7%(4/46)、13. 0%(6/46)、28. 3%(13/46),Ⅰ、Ⅱ组患者不良反应发生率显著低于Ⅲ组(χ~2=6. 915、4. 092,P <0. 05),Ⅰ、Ⅱ组患者不良反应发生率比较差异无统计学意义(χ~2=0. 453,P> 0. 05)。结论 1. 5μg·kg^(-1)舒芬太尼联合右美托咪定和地佐辛用于直肠癌根治术后镇静、镇痛效果显著,能够减少术后机体的氧化损伤,降低应激反应,抑制血小板活化,且不良反应发生率低。

Objective To investigate the effect of different doses of sufentanil combined with dexmedetomidine and dezocine on postoperative analgesia and platelet activation in patients with rectal cancer.Methods One hundred and thirty-eight patients who were given elective radical resection of rectal cancer in the First Affiliated Hospital of Henan University from June 2015 to December 2017 were divided into group Ⅰ,Ⅱ,Ⅲ,with 46 cases in each group.All patients were given general anesthesia during the operation,and intravenous analgesic pump after operation.The postoperative analgesics of group Ⅰ,Ⅱ,Ⅲ was 1.0 μg·kg^-1 sufentanil combined with 1.5 μg·kg^-1 dexmetomidine and 0.3 mg·kg^-1 dezocine,1.5 μg·kg^-1 sufentanil combined with 1.5 μg·kg^-1 dexmetomidine and 0.3 mg·kg^-1 dezocine,2.0 μg·kg^-1 sufentanil combined with 1.5 μg·kg^-1 dexmetomidine and 0.3 mg·kg^-1 dezocine.The visual analogue pain score (VAS),Ramsay sedative score and Bruggrmann comfort scale (BCS) were compared among the three groups at the time points of 1(T0),3(T1),6(T2),12(T3),24 (T4)hours after operation.The oxidative injury,stress response index,platelet activation index before and after operation and postoperative adverse reactions were compared among the three groups.Results The VAS scores in the group Ⅱ,Ⅲ were significantly lower than those in the group Ⅰ at the time points of T0,T1,T 2,T3 and T4 (P<0.05).There was no significant difference in the VAS scores and BCS scores between the group Ⅱ and group Ⅲ at the time points of T0,T1,T2,T3 and T4 (P>0.05).There was no significant difference in the Ramsay sedative scores among the three groups at the time points of T 0,T1,T2,T3 and T4 (P>0.05).There was no significant difference in the level of glutathione peroxidase (GSH-Px),lipid peroxide (LPO),epinephrine (E),norepinephrine (NE),cortisol (Cor),thrombin A2 (TXA2) and platelet granular membrane protein 140 (GMP140) among the three groups before operation (P>0.05).Compared with those before operation,the GSH-Px level was lower,and the levels of LPO,E,NE,Cor,TXA2,GMP140 was higher after operation in the three groups(P<0.05).After operation in the group Ⅱ and group Ⅲ,the GSH-Px level was higher and the level of LPO,E,NE,Cor,TXA2,GMP140 were lower than those in the group Ⅰ(P<0.05).There was no significant difference in the levels of GSH-Px,LPO,E,NE,Cor,TXA2,GMP140 between the group Ⅱ and group Ⅲ(P>0.05).The incidence of adverse reactions of the group Ⅰ,group Ⅱ,group Ⅲ was 8.7%(4/46),13.0%(6/46),28.3%(13/46),respectively.The incidence of adverse reactions of the group Ⅰ and group Ⅱ was lower than that in the group Ⅲ(P<0.05).There was no significant difference in the incidence of adverse reactions between the group Ⅰ and group Ⅱ(P>0.05).Conclusion Combined with dexmedetomidine and dizocine,1.5 μg·kg^-1 sufentanil has significant sedative and analgesic effects after radical resection of rectal cancer,which can reduce oxidative injury,reduce stress reaction,inhibit platelet activation.And the incidence of adverse reactions was low.