CAJ | 학술논문

目的：观察多模式镇痛用于肾移植患者的术后镇痛效果及对炎性细胞因子的影响。方法将40例行同种肾移植手术患者分为两组，每组20例。D组（多模式镇痛组）：超前镇痛联合硬膜外自控镇痛，C组（对照组）：间断肌内注射镇痛药物。记录术后2、6、12、24、48 h的视觉模拟法（VAS）评分、Ramsay评分及心率（HR）、平均动脉压（MAP）、脉搏血氧饮和度（SPO2）；并于麻醉前、术毕、术后6、24、48 h抽取静脉血检测血清中IL-2、IL-6和IL-10浓度。结果两组术后M A P、S PO2无明显变化，组间各时间点比较差异无统计学意义（P＞0．05）；C组术后6、12 h时HR有所升高，与D组比较差异有统计学意义（P＜0．05）。D组术后6、12、24 h VAS评分较C组低（P＜0．05）；两组各时间点Ramsay评分差异无统计学意义（P＞0．05）。两组术后6、24、48 h的IL-2和IL-10浓度明显高于麻醉前、术毕（ P＜0．05）。D组在术后6、24、48 h时IL-2、IL-6浓度明显低于C组，IL-10浓度明显高于C组（P＜0．05）。结论多模式镇痛应用于肾移植患者可达到有效的镇痛效果，并可下调促炎性细胞因子和上调抗炎性细胞因子，维持术后血清细胞因子的平衡。
목적：관찰다모식진통용우신이식환자적술후진통효과급대염성세포인자적영향。방법장40례행동충신이식수술환자분위량조，매조20례。D조（다모식진통조）：초전진통연합경막외자공진통，C조（대조조）：간단기내주사진통약물。기록술후2、6、12、24、48 h적시각모의법（VAS）평분、Ramsay평분급심솔（HR）、평균동맥압（MAP）、맥박혈양음화도（SPO2）；병우마취전、술필、술후6、24、48 h추취정맥혈검측혈청중IL-2、IL-6화IL-10농도。결과량조술후M A P、S PO2무명현변화，조간각시간점비교차이무통계학의의（P＞0．05）；C조술후6、12 h시HR유소승고，여D조비교차이유통계학의의（P＜0．05）。D조술후6、12、24 h VAS평분교C조저（P＜0．05）；량조각시간점Ramsay평분차이무통계학의의（P＞0．05）。량조술후6、24、48 h적IL-2화IL-10농도명현고우마취전、술필（ P＜0．05）。D조재술후6、24、48 h시IL-2、IL-6농도명현저우C조，IL-10농도명현고우C조（P＜0．05）。결론다모식진통응용우신이식환자가체도유효적진통효과，병가하조촉염성세포인자화상조항염성세포인자，유지술후혈청세포인자적평형。
Objective To investigate the effect of the multimodal analgesia on postoperative pain after renal transplantation and the cytokines .Methods 40 cases of allogaft renal transplantation due to chronic renal failure were randomly divided into two groups (n=20) .The group D received the multimodal analgesia :preemptive analgesia plus patient controlled epidural analgesia(PCEA) and the group C(control) received analgesic drugs by intermittent intramuscular injection .The visual analogue scale(VAS) scores , the Ramsay sedation scores ,HR ,MAP and SPO2 at postoperative 2 ,6 ,12 ,24 ,48 h were recorded .Blood interleukin-2(IL-2) ,in-terleukin-6(IL-6) and interleukin-10(IL-10) levels were measured before anesthesia ,at the end of operation and postoperative 6 , 24 ,48 h .Results Postoperative MAP and SPO2 had no obvious change in the two groups ,no statistical differences in the various time points existed between the two groups (P>0 .05) .HR was significantly increased at 6 ,24 h after operation in the group C , which had statistical difference compared with that at the same time points in the group D (P<0 .05) .The VAS scores at postoper-ative 6 ,12 ,24 h in the group D were significantly lower than those in the group C ,the difference showed statistical significance (P<0 .05) .The sedation scores at various time points had no statistical difference between the two groups (P>0 .05) .The levels of IL-2 and IL-10 at postoperative 6 ,24 ,48 h in the two groups were significantly higher than those before anesthesia and at the end of operation (P<0 .05) .The levels of IL-2 and IL-6 at postoperative 6 ,24 ,48 h in the group D were significantly lower than those in the group C(P<0 .05) .Conclusion Multimodal analgesia can reach the effective analgesic effect ,down-regulate the pro-inflam-matory cytokines and up-regulate anti-inflammatory cytokines for maintaining postaperative serum cytokines balance .