地佐辛超前镇痛对全膝关节置换术患者围术期细胞因子的影响

目的：探讨地佐辛超前镇痛对全膝关节置换术患者围术期白介素-6（IL-6）、白介素-8（m-8）和肿瘤坏死因子-α（TNF-α）浓度的影响。方法：40例择期行单侧全膝关节置换术患者，随机分为超前镇痛组（实验组）和术后镇痛组（对照组），每组20例。均采用蛛网膜下腔麻醉，患者静脉自控镇痛（PCIA）：地佐辛0．8mg／kg，生理盐水稀释至100mL。负荷剂量：5mL，持续剂量：2mL／h，追加剂量：0．5mL／次，锁定时间：15min。实验组于入室后10分钟麻醉操作前开始静脉负荷量和背景量，对照组于术毕开始PCIA镇痛，方法同实验组，记录患者术后6、8、12、24小时的疼痛视觉模拟评分（VAS评分）以及术后48小时内患者恶心呕吐的发生情况，于入室后10分钟麻醉操作前（T1）、手术开始后10分钟（T2）、术毕2h（T3）、4h（T4）、8h05）、24h（T6）时间点抽取静脉血样，测定细胞因子IL-6、IL-8、TNF-α水平。结果：术后6h、8h、12h时间点VAS评分实验组较对照组明显降低（P〈0．05），24hVAS评分变化不大，无统计学差异（P〉0．05）。术后48小时内，实验组发生恶心呕吐1例，对照组2例。与本组T1比较，血浆IL-6、IL．8浓度实验组在各时点变化不大，无统计学差异（P〉0．05），对照组浓度升高（P〈0．05）。组间比较，相同时点血浆IL-6、IL-8浓度实验组均低于对照组（P〈0．05）。两组血浆TNF-α浓度比较差异无统计学意义（P〉0．05）。结论：全膝关节置换术术前预先给予地佐辛可产生良好的超前镇痛效果，减少患者围术期细胞因子的产生。

Effect of Decocine Preemptive Analgesia on Peri-operative Cytokine in Patients Undergoing Total Knee Arthroplasty Surgery

Objective： To investigate the effect ofdecocine preemptive analgesia on peri-operative interleukin -6 （IL-6）, interleukin -8 （IL-8） and tumor necrosis factor -α（TNF-α in patients undergoing total knee arthroplasty surgery. Methods： 40 cases of selective uni- lateral total knee axthroplasty were randomly divided into 2 groups ： the preemptive analgesia group （experimental group of 20 patients） and postoperative analgesia group （control group of 20 patients）. Both groups were undergoing subarachnoid anesthesia. Patient con- trolled intravenous analgesia （PCIA）： decocine 0.8rag per kilogram, saline diluted to 100 mL. Loading dose： 5 mL, continuous dose： 2 mL per hour, additional dose： 0.5 mL per second, lockout time： 15min. Experimental group began intravenous loading dose and back- ground dose at 10 minutes after entering the OR before the anesthesia started, control group began PICA after the surgery, the methods were the same as the experimental group. The patients pain visual analog scale （VAS score） at 6,8,12,24 hours after operation and post- operative nausea and vomiting within 48h were recorded. Blood samples were collected at following time points： 10 minutes after enter- ing the OR before anesthesia performed（T1）, 10 minutes after the operation started（T2）, post-operation 2h（T3）, 4h（T4）, 8h（T5）, 24h（T6）, and the levels of cytokines IL-6, IL-8 and TNF-α were measured. Results： At 6h, 8h and 12h post-, the VAS score were lower than the control group （P〈0.05）, and there was no significant difference at 24h VAS score （P〉0.05）. There was one patient in experimental group and two patients in control group were recoded to had nausea and vomiting within 48h after operation. Compared with T1 within the group, there was no significant difference of plasma IL-6 and IL-8 concentration at each time point in the experimental group（P〉0.05）, but increased significantly in control group（P〈0.05）. Compared between the two groups, at the same time, plasma IL-6 and 1L-8 concen- tration in the experimental group were all lower than the control group （P〈0.05）. And the differences of plasma TNF-α concentration be- tween two groups were not considered statistically significant （P〉0.05）. Conclusion： Preoperatively-administered decocine during total knee arthroplasty can produce better effect of preemptive analgesia, reduce the production of peri-operative cytokines in patients under- going total knee arthroplasty.