地佐辛联合舒芬太尼术后镇痛对老年直肠癌根治术患者术后抑郁的影响

Effect of postoperative analgesia with dezocine combined with sufentanil on postoperative depression in elderly patients undergoing radical resection of rectal cancer

目的探讨地佐辛联合舒芬太尼术后镇痛对老年直肠癌根治术患者术后抑郁症状和血清5-羟色胺(5-HT)、去甲肾上腺素(NE)水平的影响。方法选取我院收治的拟行直肠癌根治术的150例老年患者,并根据随机数字表法分为对照组(n=75)和观察组(n=75),对照组术后给予舒芬太尼镇痛,观察组术后给予地佐辛联合舒芬太尼镇痛。比较2组患者镇痛、镇静效果,术后抑郁和焦虑情况,血清5-HT、NE水平变化,术后恢复情况以及围术期不良反应发生情况。结果观察组术后48 h疼痛数字评价量表(NRS)评分和患者自控镇痛(PCA)按压次数低/少于对照组(P<0.05)。2组患者术后6 h、12 h、24 h、48 h时的Ramsay镇静评分组内、组间比较差异均无统计学意义(P>0.05)。2组患者术后3 d贝克抑郁自评量表(BDI)评分、贝克焦虑自评量表(BAI)评分均高于术前(P<0.05);观察组术后3 d BDI评分低于对照组(P<0.05)。对照组术后1 d、3 d血清5-HT、NE水平低于术前(P<0.05);观察组术后1 d、3 d血清5-HT、NE水平均高于对照组(P<0.05)。观察组术后3 d 15项恢复质量量表(QoR-15)评分高于对照组(P<0.05)。2组患者术后恢复行走时间、胃肠功能恢复时间、住院时间及围术期不良反应发生率比较差异均无统计学意义(P>0.05)。结论地佐辛联合舒芬太尼术后镇痛可缓解老年直肠癌根治术患者术后抑郁症状,提高术后恢复质量。

Objective To investigate the effect of postoperative analgesia with dezocine combined with sufentanil on postoperative depressive symptoms and the levels of serum 5-hydroxytryptamine(5-HT),norepinephrine(NE)in elderly patients undergoing radical resection of rectal cancer.Methods A total of 150 elderly patients who were prior to undergo radical resection of rectal cancer in our hospital were selected and divided into the control group(n=75)and the observation group(n=75)according to the random number table method.The control group was given sufentanil for postoperative analgesia,and the observation group was given dezocine combined with sufentanil for postoperative analgesia.The analgesic and sedative effects,postoperative depression and anxiety,changes of serum 5-HT and NE levels,postoperative recovery and the incidence of perioperative adverse reactions of the two groups were compared.Results The pain numerical rating scale(NRS)score 48 hours after operation and patient-controlled analgesia(PCA)pressing times in the observation group were lower/less than those in the control group(P<0.05).There was no statistically significant difference in the Ramsay sedation score within or between the two groups 6 hours,12 hours,24 hours and 48 hours after operation(P<0.05).The Beck depression inventory(BDI)score and Beck anxiety inventory(BAI)score 3 days after operation in the two groups were higher than those before operation(P<0.05);and the BDI score 3 days after operation in the observation group was lower than that in the control group(P<0.05).The levels of serum 5-HT and NE 1 day and 3 days after operation in the control group were lower than those before operation(P<0.05).The levels of serum 5-HT and NE 1 day and 3 days after operation in the observation group were higher than those in the control group(P<0.05).The quality of recovery-15(QoR-15)score 3 days after operation in the observation group was higher than that in the control group(P<0.05).There was no statistically significant difference in the postoperative recovery time of walking,gastrointestinal function recovery time,hospital stay or the incidence of perioperative adverse reactions between the two groups(P>0.05).Conclusion Postoperative analgesia with dezocine combined with sufentanil can relief the postoperative depressive symptoms and improve the quality of postoperative recovery in elderly patients undergoing radical resection of rectal cancer.