中国医学前沿杂志（电子版）
中國醫學前沿雜誌（電子版）
중국의학전연잡지（전자판）
CHINESE JOURNAL OF THE FRONTIERS OF MEDICAL SCIENCE(ELECTRONIC VERSION)
2014年
10期
16-19
,共4页
地佐辛%芬太尼%镇痛%冠心病%心肌%细胞因子类
地佐辛%芬太尼%鎮痛%冠心病%心肌%細胞因子類
지좌신%분태니%진통%관심병%심기%세포인자류
Dezocine combined%Fentanyl%Analgesia%Coronary artery disease%Myocardium%Cytokines
目的探讨地佐辛联合芬太尼对冠心病患者非心脏手术术后镇痛及心肌损伤的影响。方法将40例心功能Ⅰ或Ⅱ级择期行上腹部手术的冠心病患者随机分为地佐辛组（F组）与对照组（C组），每组各20例。分别于气管插管后（切皮前15分钟）静脉注射地佐辛3 mg/kg（F组）和安慰剂（C组）各10 ml。两组患者术后均行静脉自控镇痛（PCIA）。连续监测患者血流动力学及心电图变化，记录患者苏醒后、术后4、8、12、24、48小时视觉模拟评分（VAS），在术前（T1）、手术2小时（T2）、术毕（T3）及术后24小时（T4）检测肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）及心肌肌钙蛋白I（cTnI）浓度。结果 F组患者于苏醒后及术后4、8小时VAS评分明显低于C组（P＜0.05)；F组患者在T2～T3时点血清TNF-α含量低于C组（P＜0.05）；在T2～T4时点，F组血清IL-6含量及cTnI浓度低于C组，血清IL-10含量高于C组（P＜0.05）。结论地佐辛联合芬太尼能够提高冠心病患者非心脏手术术后镇痛的效果，减轻心肌损伤。
目的探討地佐辛聯閤芬太尼對冠心病患者非心髒手術術後鎮痛及心肌損傷的影響。方法將40例心功能Ⅰ或Ⅱ級擇期行上腹部手術的冠心病患者隨機分為地佐辛組（F組）與對照組（C組），每組各20例。分彆于氣管插管後（切皮前15分鐘）靜脈註射地佐辛3 mg/kg（F組）和安慰劑（C組）各10 ml。兩組患者術後均行靜脈自控鎮痛（PCIA）。連續鑑測患者血流動力學及心電圖變化，記錄患者囌醒後、術後4、8、12、24、48小時視覺模擬評分（VAS），在術前（T1）、手術2小時（T2）、術畢（T3）及術後24小時（T4）檢測腫瘤壞死因子-α（TNF-α）、白細胞介素-6（IL-6）、白細胞介素-10（IL-10）及心肌肌鈣蛋白I（cTnI）濃度。結果 F組患者于囌醒後及術後4、8小時VAS評分明顯低于C組（P＜0.05)；F組患者在T2～T3時點血清TNF-α含量低于C組（P＜0.05）；在T2～T4時點，F組血清IL-6含量及cTnI濃度低于C組，血清IL-10含量高于C組（P＜0.05）。結論地佐辛聯閤芬太尼能夠提高冠心病患者非心髒手術術後鎮痛的效果，減輕心肌損傷。
목적탐토지좌신연합분태니대관심병환자비심장수술술후진통급심기손상적영향。방법장40례심공능Ⅰ혹Ⅱ급택기행상복부수술적관심병환자수궤분위지좌신조（F조）여대조조（C조），매조각20례。분별우기관삽관후（절피전15분종）정맥주사지좌신3 mg/kg（F조）화안위제（C조）각10 ml。량조환자술후균행정맥자공진통（PCIA）。련속감측환자혈류동역학급심전도변화，기록환자소성후、술후4、8、12、24、48소시시각모의평분（VAS），재술전（T1）、수술2소시（T2）、술필（T3）급술후24소시（T4）검측종류배사인자-α（TNF-α）、백세포개소-6（IL-6）、백세포개소-10（IL-10）급심기기개단백I（cTnI）농도。결과 F조환자우소성후급술후4、8소시VAS평분명현저우C조（P＜0.05)；F조환자재T2～T3시점혈청TNF-α함량저우C조（P＜0.05）；재T2～T4시점，F조혈청IL-6함량급cTnI농도저우C조，혈청IL-10함량고우C조（P＜0.05）。결론지좌신연합분태니능구제고관심병환자비심장수술술후진통적효과，감경심기손상。
ObjectiveTo investigate the analgesic effect and impact on myocardial injury of the lipid microspheres dezocine combined injection in patients with coronary heart disease undergoing noncardiac surgery.Method40 patients with coronary artery disease and heart function scale of 1 or 2 scheduled for epigastric operation were randomly divided into two groups of F (dezocine combined 3 mg/kg) and C (fat emulsion 10 ml) with 20 cases each. The drugs were intravenously injected 15 minutes before skin incision. Hemodynamics and ECG were monitored continuously. The values of VAS scores were recorded at after awaking and at 4 hours, 8 hours, 12 hours, 24 hours, 48 hours after operation. Blood samples were taken for determination of serum levels of TNF-α, IL-6, IL-10 and cTnI before operation (T1), at 2 hours of operation (T2), immediately after the end of operation (T3) and 24 hours after operation (T4).ResultThe VAS scores was lower in group F than in group C at after awaking and 4 hours, 8 hours after operation (P<0.05). TNF-αwas decreased at T2~T3 in group F than that in group C (P<0.05). The value of IL-6 and the level of cTnI were decreased and the value of IL-10 was increased at T2~T4 in group F than those in group C (P<0.05). ConclusionDezocine combined with fentanyl injection could improve the analgesia effects, alleviate postoperative myocardial injury in patients with coronary heart disease undergoing noncardiac surgery. Suppression of inlfammatory response may contribute to the mechanism.
