余清文,蒋玲,何祥
YU Qingwen,JIANG Ling,HE Xiang

• 1:乐山市中医医院
• 2:贵州省人民医院

摘要(Abstract)：

目的:评估盐酸氢吗啡酮硬膜外超前镇痛用于前列腺电切术的效果及机制。方法:将前列腺增生行等离子前列腺电切术的100例患者随机均分为对照组和观察组,两组患者均采用常规腰硬联合麻醉,观察组在麻醉后硬膜外腔给予盐酸氢吗啡酮0.3 mg,对照组给予同等剂量的生理盐水;记录两组患者麻醉前(T0)、麻醉后10 min(T1)、手术结束时(T2)、手术结束后24 h(T3)时的平均血压(MAP)、心率(HR),记录T2、T3时点VAS疼痛和Ramsay镇静评分,采用酶联免疫吸附法(ELISA)测定T0、T2、T3时点血清P物质(SP)、缓激肽(BK)、组织胺(HIS)、白介素-6(IL-6)、白介素-10(IL-10)、白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、促肾上腺皮质激素(ACTH)、皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)的含量,记录术毕至术后24 h内地佐辛的用药量。结果:与对照组比较,观察组T2、T3时点MAP、HR、VAS疼痛评分、SP、BK、HIS、IL-6、IL-1β、TNF-α、ACTH、Cor、E及NE的含量显著降低,Ramsay镇静评分及IL-10的含量显著升高(P<0.05),术毕至术后24 h时地佐辛补救用药量明显低于对照组(P<0.05)。结论:盐酸氢吗啡酮椎管内注射对前列腺增生患者行等离子前列腺电切术的术后镇痛具有良好的效果,其机制可能与减少前列腺患者疼痛介质及炎症因子的分泌、抑制术后应激反应有关。
Objective: To evaluate the efficacy and safety of preemptive analgesia with hydromorphone hydrochloride by epidural administrationfor transurethral resection of prostate.Methods:100 patients underwent transurethral resection of prostate were randomly divided into control group and treatment group.Both groups were treated with combined spinal-epidural anesthesia.Then treatment group received 0.3 mg hydromorphone hydrochloride to the epidural space,and the control group was admi-nistrated with the same dose of saline.The mean blood pressure(MAP),heart rate(HR),VAS pain and Ramsay sedation scores of the two groups were recorded before anesthesia(T0),10 min after anesthesia(T1),at the end of surgery(T2),24 h after surgery(T3).The enzyme-linked immunosorbent assay(ELISA) was used to measure the level of substance P(SP),bradykinin(BK),histamine(HIS),interleukin-6(IL-6),interleukin-10(IL-10),interleukin-1β(IL-1β),tumor necrosis factor-α(Tumor necrosis factor,TNF-α),adrenocorticotropic hormone(ACTH),cortisol(Cor),adrenaline(E) and norepinephrine(Norepinephrine,NE) at T0,T2 and T3.Finally,the dose of dezocine was recorded within 24 hours after surgery.Results:Compared with the control group,the treatment group showed a significant decrease in MAP,HR,VAS pain score and a significant increase in the Ramsay sedation score(P<0.05).At the same time,the levels of SP,BK,HIS,IL-6,IL-1β,TNF-α,ACTH,Cor,E and NE in the treatment group were significantly lower than those in the control group(P<0.05).24 hours after surgery,the dose of dezocine in the treatment group was significantly lower than that in the control group(P<0.05).Conclusion:Preemptive analgesia withhydromorphone hydrochlorideshows good analgesic effect,which can reduce the production of pain mediators,secretion of inflammatory factors,and inhibit postoperative stress response.

关键词(KeyWords)： 盐酸氢吗啡酮;硬膜外腔;超前镇痛;前列腺电切术;疼痛介质;炎症因子;应激激素
hydromorphone hydrochloride;epidural administration;preemptive analgesia;transurethral resection of prostate;pain mediators;inflammatory factors;stress response

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金资助项目(81860234);; 贵州省卫生计生委科学技术基金资助项目(gzwjkj2018-1-018)

作者(Author): 余清文,蒋玲,何祥
YU Qingwen,JIANG Ling,HE Xiang

DOI: 10.19367/j.cnki.1000-2707.2019.08.016

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