地佐辛在老年恶性肿瘤患者术后镇痛中的应用效果及对应激反应的作用研究

Effect of Dezocine on Postoperative Analgesia in Elderly Patients with Malignant Tumor and Its Effect on Stress Response

目的 :分析地佐辛在老年恶性肿瘤患者手术后的镇痛效果及对应激反应的作用,为临床老年恶性肿瘤患者术后镇痛药的选择提供参考。方法 :选择2015年1月—2016年1月在我院手术治疗的老年胸科恶性肿瘤患者128例作为研究对象,按照随机数字表法分为对照组和观察组,各64例。对照组在检测疼痛程度、呼吸幅度及意识的情况下,于手术结束前30 min开始采用小剂量多次静脉注射苏芬太尼(10μg)镇痛,观察组在对照组基础上加用地佐辛(10 mg,q8h)。比较两组术后8 h、12 h、24 h及48 h的视觉模拟评分法(VAS)评分及术前、术后12 h、24 h、48 h肾上腺素和去甲肾上腺素、凝血功能(纤维蛋白原、血小板计数)、免疫指标(CD3^+、CD4^+)的变化,以及应激相关并发症的发生情况。结果 :术后8 h、12 h、24 h、48 h观察组VAS评分均明显低于对照组,差异有统计学意义(P <0.05);术后12 h、24 h、48 h观察组肾上腺素、去甲肾上腺素、纤维蛋白原、血小板活性明显低于对照组,CD3^+、CD4^+水平明显高于对照组,差异有统计学意义(P <0.05);观察组术后1周内应激相关性并发症率明显低于对照组,差异有统计学意义(P <0.05)。结论 :地佐辛联合苏芬太尼用于老年恶性肿瘤患者术后镇痛,可有效提升镇痛效果,控制凝血功能及免疫反应变化,降低术后应激相关并发症的发生率,具有较高的临床价值。

Objective: To analyze the effect of dezocine on postoperative analgesia in elderly patients with malignant tumor and its effect on stress response. Methods: 128 elderly patients with thoracic malignant tumor who were given surgical treatment in our hospital from January 2015 to January 2016 were selected as subjects investigated and randomly divided into control group and observation group, 64 patients in each group. The patients in the control group were given intravenous injection of low-dose sufentanil (10 μg) at 30 minutes before the end of the surgery in the case of detecting pain degree, respiratory amplitude and consciousness, and the patients in the observation group were further treated with dezocine (10 mg, q8 h) based on the control group. The visual analogue scale (VAS) scores at 8 h, 12 h, 24 h and 48 h after surgery, adrenaline, norepinephrine, coagulation function (fibrinogen, platelet count), changes of immune indexes (CD3^+, CD4^+) before surgery and at 12 h, 24 h and 48 h after surgery and occurrence of stress-related complications were compared between the two groups. Results: The VAS scores at 8 h, 12 h, 24 h and 48 h after surgery in the observation group were significantly lower than those in the control group (P<0.05). The adrenaline, norepinephrine, fibrinogen, platelet activity at 12 h, 24 h and 48 h after surgery in the observation group were significantly lower than those in the control group, and the levels of CD3^+ and CD4^+ in the observation group were significantly higher than those in the control group (P<0.05). The incidence of stress-related complications one week after surgery in the observation group was significantly lower than that in the control group (P<0.05). Conclusion: Dezocine combined with sufentanil for postoperative analgesia in elderly patients with malignant tumors can effectively improve analgesic effect, control coagulation function and immune response changes and reduce the incidence of postoperative stress-related complications, and has high clinical value.