硬膜外自控镇痛对子宫全切术患者术后细胞因子及疼痛程度的影响观察

Effects of Epidural Controlled Analgesia on Postoperative Cytokines and Degree of Pain in Patients Undergoing Total Hysterectomy

目的:分析硬膜外自控镇痛对子宫全切术患者术后细胞因子及疼痛程度的影响。方法:回顾性选取佳木斯市妇幼保健院2019年2月-2022年2月收治的行子宫全切术患者82例,按照镇痛方式的不同将患者分为常规镇痛组(38例)、自控镇痛组(44例),常规镇痛组患者采用常规镇痛、自控镇痛组患者采用硬膜外自控镇痛。分析比较两组患者应激情况、血液流变学、细胞因子、疼痛程度及术后并发症的发生情况。结果:术后2、24、72 h,两组Cor、ALD水平均较术前有所上升,且两组术后2 h的Cor、ALD水平均高于术后24、72 h,且与常规镇痛组相比,自控镇痛组患者术后2、24、72 h的Cor、ALD水平均更低,差异均有统计学意义(P<0.05)。术后2、24、72 h,两组全血高切黏度、全血低切黏度均较术前有所下降,且与常规镇痛组相比,自控镇痛组术后2、24、72 h 全血高切黏度、全血低切黏度均较低,差异均有统计学意义(P<0.05)。与术前比较,术后2、24、72 h,两组IL-6、IL-10水平均有所上升,术后2 h两组IL-6、IL-10水平均高于术后24、72 h,且与常规镇痛组相比,自控镇痛组患者术后2、24、72 h的IL-6、IL-10水平均更低,差异均有统计学意义(P<0.05)。自控镇痛组术后2、24、72 h的VAS评分均低于常规镇痛组,差异均有统计学意义(P<0.05)。常规镇痛组不良反应发生率高于自控镇痛组,差异有统计学意义(P<0.05)。结论:给予子宫全切术患者硬膜外自控镇痛干预,对患者应激指标、血液流变学的影响较小,且能够改善患者术后细胞因子的表达,降低患者术后疼痛程度,有着较好的干预效果。

Objective:To analyze the effects of epidural controlled analgesia on postoperative cytokines and pain levels in patients undergoing total hysterectomy.Method:A total of 82 patients who underwent total hysterectomy in Jiamusi Maternal and Child Health Hospital from February 2019 to February 2022 were retrospectively selected,and the patients were divided into conventional analgesia group (38 cases),controlled analgesia group (44 cases),and conventional analgesia group patients were treated with epidural controlled analgesia.Stress,hemorheology,cytokines,pain level,and occurrence of postoperative complications were analyzed and compared between the two groups.Result:At 2,24 and 72 h after operation,the levels of Cor and ALD in the two groups increased compared with those before operation,and the levels of Cor and ALD at 2 h after operation in the two groups were higher than those at 24 and 72 h after operation,compared with the conventional analgesia group,the levels of Cor and ALD at 2,24 and 72 h after operation in the controlled analgesia group were lower,the differences were statistically significant (P<0.05).At 2,24 and 72 h after operation,the whole blood high shear viscosity and whole blood low shear viscosity in the two groups decreased compared with those before operation,and compared with the conventional analgesia group,the whole blood high shear viscosity and whole blood low shear viscosity in the controlled analgesia group at 2,24 and 72 h were lower,the differences were statistically significant (P<0.05).Compared with before operation,the levels of IL-6 and IL-10 in the two groups increased at 2,24 and 72 h after operation,at 2 h after operation,the levels of IL-6 and IL-10 in the two groups were higher than those at 24 and 72 h after operation,compared with the conventional analgesia group,the levels of IL-6 and IL-10 in the controlled analgesia group were lower at 2,24 and 72 h after operation,the differences were statistically significant (P<0.05).The VAS scores of controlled analgesia group at 2,24 and 72 h after operation were lower than those of conventional analgesia group,the differences were statistically significant (P<0.05).The incidence of adverse reactions in conventional analgesia group was significantly higher than that in controlled analgesia group,the differences were statistically significant (P<0.05).Conclusion:Epidural controlled analgesia intervention for patients undergoing total hysterectomy has little effect on patients’ stress indexes and hemorheology,and can improve the expression of cytokines and reduce the degree of postoperative pain,with a better intervention effect.