羟考酮与芬太尼静脉自控镇痛对宫颈癌术后疼痛程度、免疫应答及应激反应影响的比较

Comparison of the effects of oxycodone and fentanyl PCIA on postoperative pain, immune response and stress response in patients with cervical cancer

目的:对比羟考酮、芬太尼静脉自控镇痛(PCIA)对宫颈癌术后疼痛程度、免疫应答及应激反应影响的差异。方法:选择在本院接受宫颈癌根治术治疗的早期宫颈癌患者110例,随机分为对照组、研究组各55例。对照组接受术后芬太尼PCIA、研究组接受术后羟考酮PCIA,对比两组术后即刻、术后24 h的视觉模拟评分(VAS)及血清疼痛介质[5-羟色胺(5-HT)、P物质(SP)、前列腺素(PG)]、Th1/Th2细胞因子[白介素-2(IL-2)、肿瘤坏死因子β(TNF-β)、白介素-5(IL-5)、白介素-13(IL-13)]、应激激素[皮质醇(Cor)、去甲肾上腺素(NE)、血管紧张素1(Ang-1)、血管紧张素2(Ang-2)]含量的差异。结果:术后即刻,两组VAS评分值,血清疼痛介质、Th1/Th2细胞因子、应激激素含量比较,差异无统计学意义(P>0.05)。术后24 h,研究组VAS评分值低于对照组;血清5-HT、SP、PG含量低于对照组;血清IL-2、TNF-β的含量低于对照组,IL-5、IL-13的含量高于对照组;血清Cor、NE、Ang-1、Ang-2的含量低于对照组(P<0.05)。结论:宫颈癌术后接受羟考酮PCIA,相较于常规芬太尼PCIA,在镇痛及稳定内环境方面更具优势。

Objective:To compare the effects of oxycodone and fentanyl patient-controlled intravenous analgesia(PCIA) on postoperative pain,immune response and stress response in patients with cervical cancer.Methods:110patients with early cervical cancer who received radical hysterectomy in our hospital between January 2017and January 2019were divided into the control group(n=55)and the study group(n=55)by random number table method.Control group received postoperative fentanyl PCIA,and study group received postoperative oxycodone PCIA.The differences in visual analogue scale(VAS)as well as serum contents of pain mediators[5-hydroxytryptamine(5-HT),substance P(SP)and prostaglandin(PG)],Th1/ Th2cytokines[interleukin-2(IL-2),tumor necrosis factorβ(TNF-β),interleukin-5(IL-5)and interleukin-13(IL-13)]and stress hormones[cortisol(Cor),norepinephrine(NE),angiotensin 1(Ang-1)and angiotensin 2(Ang-2)]immediately after surgery and 24hafter surgery were compared between the two groups of patients.Results:Immediately after surgery,there was no statistically significant difference in VAS as well as serum contents of pain mediators,Th1/Th2cytokines and stress hormones between the two groups(P>0.05).24hafter surgery,the VAS of the study group was lower than that of the control group;serum levels of 5-HT,SP and PG were lower than those of the control group;serum levels of IL-2 and TNF-β were lower than those of the control group while the levels of IL-5and IL-13were higher than those of the control group;serum levels of Cor,NE,Ang-1and Ang-2 were lower than those of the control group(P<0.05).Conclusion:Compared with conventional fentanyl PCIA,oxycodone PCIA after cervical cancer surgery has more advantages in analgesia and homeostasis.