摘要
目的 :比较氢吗啡酮静脉自控镇痛(patient-controlled intravenous analgesia,PCIA)与皮下注射对口腔肿瘤患者术后镇痛的疼痛控制效果及安全性。方法:选择2022年1月—2023年3月上海交通大学医学院附属第九人民医院收治的口腔肿瘤术后患者200例,根据随机数表法分为试验组和对照组,每组各100例。试验组采用氢吗啡酮PCIA镇痛,对照组采用氢吗啡酮皮下注射镇痛。比较2组疼痛控制效果(BPI-C评分)、血清标志物[前列腺素E2(PGE2)、5羟色胺(5-HT)、一氧化氮(NO)、生长激素(GH)、皮质醇(Cor)、泌乳素(PRL)]、炎症因子表达水平[血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、白细胞介素1β(IL-1β)]、睡眠质量(失眠严重指数)及安全性。采用SPSS 23.0软件包对数据进行统计学分析。结果:术后48 h,试验组BPI-C评分中的目前疼痛程度、平均疼痛程度、过去24 h内最痛的疼痛程度、过去24 h内最轻的疼痛程度、过去24 h内接受疼痛处置后疼痛缓解程度评分及PGE2、5-HT、NO、GH、Cor、PRL、TNF-α、IL-6、IL-1β水平显著低于对照组(P<0.05);术后1周,试验组ISI评分中的入睡困难、睡眠维持困难、早醒、睡眠模式、日常功能、生活质量、睡眠问题评分显著低于对照组(P<0.05);试验组不良反应发生率为10.00%,对照组为13.00%,差异无统计学意义(P>0.05)。结论:口腔肿瘤术后患者应用氢吗啡酮PCIA,不仅能有效缓解疼痛感受,还能降低血清疼痛介质及炎症因子表达,进而减轻应激反应,改善患者睡眠质量,且不会增加不良反应发生率,值得临床推广。
PURPOSE:To compare pain control effect and safety of hydromorphone patient-controlled intravenous analgesia(PCIA)and subcutaneous injection for patients after oral tumor surgery.METHODS:A total of 200 patients after oral tumor surgery from January 2022 to March 2023 in Shanghai Ninth People's hospital were selected and divided into two groups according to the random number table method(control group,n=100,who received subcutaneous injection of hydromorphone;experimental group,n=100,who received hydromorphone PCIA).Chinese version of the brief pain inventory(BPI-C),serum markers[prostaglandin E2(PGE2),5-hydroxytryptamine(5-HT),nitric oxide(NO),and growth hormone(GH)],expression levels of inflammatory factors[serum tumor necrosis factor-α,(TNF-α),interleukin 6(IL-6),interleukin 1β(IL-1β)],sleep quality[insomnia severity index(ISI)],and the incidence of adverse reactions were compared between the two groups.SPSS 23.0 software package was used for data analysis.RESULTS:Forty-eight hours after surgery,BPI-C score of the experimental group including current pain degree,average pain degree,most painful pain degree in the past 24 hours,least painful pain degree in the past 24 hours,pain relief degree after pain treatment in the past 24 hours,and the levels of PGE2,5-HT,NO,GH,Cor,PRL,TNF-α,IL-6 and IL-1βwere significantly lower than those of the control group(P<0.05).One week after surgery,ISI scores in the experimental group were significantly lower than those in the control group(P<0.05).The incidence of adverse reactions was 10.00%in experimental group and 13.00%in control group,with no significant difference(P>0.05).CONCLUSIONS:Application of hydromorphone PCIA in postoperative patients with oral tumors can not only effectively relieve the pain perception of patients,but also reduce the expression of pain mediators and inflammatory factors in serum,thus alleviating the stress response.It can also help improving the sleep quality of patients,while not increase the occurrence of adverse reactions.So it is worthy of clinical application.
作者
王圆
支延康
WANG Yuan;ZHI Yan-kang(Department of Anesthesiology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine.Shanghai 200011,China)
出处
《中国口腔颌面外科杂志》
CAS
2024年第1期53-57,共5页
China Journal of Oral and Maxillofacial Surgery
关键词
氢吗啡酮
静脉自控镇痛
皮下注射
口腔肿瘤
术后镇痛
Hydromorphone
Intravenous controlled analgesia
Subcutaneous injection
Oral tumor
Postoperative analgesia