羟考酮与氢吗啡酮对腹腔镜胆囊切除术后疼痛及炎症细胞因子的影响

Effect of Oxycodone and Hydromorphone on pains and inflammatory cytokines of patients after laparoscopic cholecystectomy

摘要:

目的探讨羟考酮与氢吗啡酮对腹腔镜胆囊切除术后疼痛及炎症细胞因子的影响，为合理使用麻醉镇痛药，有效缓解术后疼痛及细胞因子失衡提供科学依据。方法选取拟行腹腔镜胆囊切除术患者40 例，随机分为羟考酮组（A 组）、氢吗啡酮组（B 组），每组各20 例。手术结束时，A 组给予羟考酮0.1 mg/kg，B组给予氢吗啡酮2 mg，C 组给予生理盐水2 ml。记录3 组患者术后4、6、12和24 h的VAS 评分，并在麻醉前和术后4、12和24 h检测血清IL-6 和IL-10 的水平。结果A 组与B 组术后不同时间点VAS 评分、Ramsay评分、血清IL-6、血清IL-10组内比较，差异有统计学意义（p <0.05）；A 组与B 组相比，VAS 评分、Ramsay 评分、血清IL-6、血清 IL-10组内整体比较，差异无统计学意义（p >0.05）；麻醉后，A 组与B 组血流动力学指标比较，差异有统计学意义（p <0.05），B组患者优于A 组。结论羟考酮与氢吗啡酮各自均可有效缓解腹腔镜胆囊切除术患者的术后疼痛，同时能够调节促炎与抗炎细胞因子平衡，减弱炎症反应，促进术后康复。

Abstract:

Objective To explore the effect of Hydromorphone and Oxycodone on pains and inflammatory cytokines of patients after laparoscopic cholecystectomy, so as to provide scientific basis for the rational use of narcotic analgesics in relieving postoperative pains and balancing the inflammatory cytokines. Methods Sixty patients who received laparoscopic cholecystectomy were randomly divided into Oxycodone group (group A), Hydromorphone group (group B) and placebo group (group C) with 20 cases in each group. At the end of surgery, the patients in the group A were given 0.1 mg/kg of Oxycodone, those in the group B were given 2 mg Hydromorphone, and those in the group C were given 2 ml of normal saline. The VAS scores were recorded at 4, 6, 12 and 24 h after surgery. The levels of serum IL-6 and IL-10 were detected before anesthesia and 4, 12 and 24 h after surgery in the three groups. Results The VAS scores and the Ramsay scores at 4 and 6 h after surgery in the groups A and B were significantly lower than those in the group C (p < 0.05). The levels of IL-6 and IL-10 at 4, 12 and 24 h after surgery were all significantly increased in the three groups compared to the levels before anesthesia (p < 0.05). The IL-6 levels at 4 and 12 h after surgery in the group A and the group B were significantly lower than those in the group C; while the levels of IL-10 at 4, 12 and 24 h after surgery in the groups A and B were significantly higher than those in the group C (p < 0.05). After anesthesia, the hemodynamic indicators of the group B were better than those in the group A, the differences were statistically significant (p < 0.05). Conclusions Both Oxycodone and Hydromorphone can effectively alleviate pains of patients after laparoscopic cholecystectomy, and also balance the pro -inflammatory and anti -inflammatory cytokines, thus reduce inflammatory reactions and boost postoperative recovery.