氢吗啡酮静脉自控镇痛对乳腺癌术后疼痛的控制作用及对患者血清5-HT和hs-CRP的影响

Postoperative Pain Control and Effects on 5-HT and hs-CRP of Hydroxymorphone Patient-controlled Intravenous Analgesia in Patients with Breast Cancer

目的:探讨氢吗啡酮静脉自控镇痛(PCIA)对乳腺癌术后疼痛的控制作用和安全性,及其对患者血清5-羟色胺(5-HT)和超敏C反应蛋白(hs-CRP)的影响。方法:行改良根治术治疗的乳腺癌患者100例随机分为舒芬太尼组和氢吗啡酮组各50例。术后舒芬太尼组给予舒芬太尼PCIA,氢吗啡酮组给予氢吗啡酮PCIA。分别应用视觉模拟评分法(VAS)、Ramsay评分于术后2,6,12,18,24 h评估观察患者镇痛和镇静效果,记录两组患者24h PCIA泵自动进药量、按压次数、实际有效进药次数,以及两组药品不良反应发生情况;分别于术后2h和术后24h检测血清5-HT和hs-CRP水平。结果:氢吗啡酮组患者术后12h、18h和24h的VAS评分和Ramsay评分均明显低于舒芬太尼组(P<0.05);术后24 h自动进药量、按压次数、实际有效进药次数均明显低于舒芬太尼组(P<0.05)。两组患者术后24 h血清5-HT和hs-CRP水平均较前显著升高(P<0.05),而氢吗啡酮组术后24 h血清5-HT和hs-CRP水平低于舒芬太尼组(P<0.05)。两组患者不良反应发生率差异无统计学意义(P>0.05)。结论:乳腺癌术后应用氢吗啡酮PCIA,具有良好的镇痛和镇静作用,且能有效降低5-HT、hs-CRP水平,安全性较好。

Objective:To explore the postoperative pain control and safety of hydromorphone patient-controlled intravenous analgesia(PCIA)in patients with breast cancer,and evaluate its effects on serotonin(5-HT)and high-sensitivity C-reactive protein(hsCRP).Methods:Totally 100 patients with breast cancer treated with modified radical mastectomy were randomly divided into sufentanil group and hydromorphone group with 50 patients in each group.After surgery,sufentanil was given to sufentanil PCIA,and hydromorphone was given hydromorphone PCIA.The analgesic and sedative effects in the patients were evaluated by visual analogue scale(VAS)score and Ramsay score at 2,6,12,18,24 and 48 h after operation.The automatic dose,compression times and actual effective doses of 24 h PCIA pump were recorded in the two groups.The serum 5-HT and hs-CRP levels were measured at 2 h and 24 h after surgery.Results:VAS score and Ramsay score of hydromorphone group at 12 h,18 h and 24 h were lower than those in sufentanil group(P<0.05).The 24 h automatic drug intake after surgery,compression times and actual effective drug intake times were significantly lower than those in sufentanil group(P<0.05).The serum 5-HT and hs-CRP levels of the two groups at 24 h after surgery were significantly higher than those before surgery(P<0.05).The HT and hs-CRP levels of hydromorphone group at 24 h after surgery were lower than those in sufentanil group(P<0.05).The adverse reactions of two groups showed no statistically significant differences(P>0.05).Conclusion:Post-operative use of hydromorphone patient-controlled intravenous analgesia in patients with breast cancer has good analgesic and sedative effects,and can effectively reduce 5-HT and hs-CRP levels with promising safety.