羟考酮与芬太尼静脉自控镇痛对宫颈癌术后疼痛程度、免疫应答及应激反应影响的比较
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摘要
目的:对比羟考酮、芬太尼静脉自控镇痛(PCIA)对宫颈癌术后疼痛程度、免疫应答及应激反应影响的差异。方法:选择在本院接受宫颈癌根治术治疗的早期宫颈癌患者110例,随机分为对照组、研究组各55例。对照组接受术后芬太尼PCIA、研究组接受术后羟考酮PCIA,对比两组术后即刻、术后24 h的视觉模拟评分(VAS)及血清疼痛介质[5-羟色胺(5-HT)、P物质(SP)、前列腺素(PG)]、Th1/Th2细胞因子[白介素-2(IL-2)、肿瘤坏死因子β(TNF-β)、白介素-5(IL-5)、白介素-13(IL-13)]、应激激素[皮质醇(Cor)、去甲肾上腺素(NE)、血管紧张素1(Ang-1)、血管紧张素2(Ang-2)]含量的差异。结果:术后即刻,两组VAS评分值,血清疼痛介质、Th1/Th2细胞因子、应激激素含量比较,差异无统计学意义(P>0.05)。术后24 h,研究组VAS评分值低于对照组;血清5-HT、SP、PG含量低于对照组;血清IL-2、TNF-β的含量低于对照组,IL-5、IL-13的含量高于对照组;血清Cor、NE、Ang-1、Ang-2的含量低于对照组(P<0.05)。结论:宫颈癌术后接受羟考酮PCIA,相较于常规芬太尼PCIA,在镇痛及稳定内环境方面更具优势。
Objective: To compare the effects of oxycodone and fentanyl patient-controlled intravenous analgesia(PCIA) on postoperative pain, immune response and stress response in patients with cervical cancer. Methods: 110 patients with early cervical cancer who received radical hysterectomy in our hospital between January 2017 and January 2019 were divided into the control group(n=55) and the study group(n=55) by random number table method. Control group received postoperative fentanyl PCIA, and study group received postoperative oxycodone PCIA. The differences in visual analogue scale(VAS) as well as serum contents of pain mediators [5-hydroxytryptamine(5-HT), substance P(SP) and prostaglandin(PG)], Th1/Th2 cytokines [interleukin-2(IL-2), tumor necrosis factor β(TNF-β), interleukin-5(IL-5) and interleukin-13(IL-13)] and stress hormones [cortisol(Cor), norepinephrine(NE), angiotensin 1(Ang-1) and angiotensin 2(Ang-2)] immediately after surgery and 24 h after surgery were compared between the two groups of patients. Results: Immediately after surgery, there was no statistically significant difference in VAS as well as serum contents of pain mediators, Th1/Th2 cytokines and stress hormones between the two groups(P>0.05). 24 h after surgery, the VAS of the study group was lower than that of the control group; serum levels of 5-HT, SP and PG were lower than those of the control group; serum levels of IL-2 and TNF-β were lower than those of the control group while the levels of IL-5 and IL-13 were higher than those of the control group; serum levels of Cor, NE, Ang-1 and Ang-2 were lower than those of the control group(P<0.05). Conclusion: Compared with conventional fentanyl PCIA, oxycodone PCIA after cervical cancer surgery has more advantages in analgesia and homeostasis.
Objective: To compare the effects of oxycodone and fentanyl patient-controlled intravenous analgesia(PCIA) on postoperative pain, immune response and stress response in patients with cervical cancer. Methods: 110 patients with early cervical cancer who received radical hysterectomy in our hospital between January 2017 and January 2019 were divided into the control group(n=55) and the study group(n=55) by random number table method. Control group received postoperative fentanyl PCIA, and study group received postoperative oxycodone PCIA. The differences in visual analogue scale(VAS) as well as serum contents of pain mediators [5-hydroxytryptamine(5-HT), substance P(SP) and prostaglandin(PG)], Th1/Th2 cytokines [interleukin-2(IL-2), tumor necrosis factor β(TNF-β), interleukin-5(IL-5) and interleukin-13(IL-13)] and stress hormones [cortisol(Cor), norepinephrine(NE), angiotensin 1(Ang-1) and angiotensin 2(Ang-2)] immediately after surgery and 24 h after surgery were compared between the two groups of patients. Results: Immediately after surgery, there was no statistically significant difference in VAS as well as serum contents of pain mediators, Th1/Th2 cytokines and stress hormones between the two groups(P>0.05). 24 h after surgery, the VAS of the study group was lower than that of the control group; serum levels of 5-HT, SP and PG were lower than those of the control group; serum levels of IL-2 and TNF-β were lower than those of the control group while the levels of IL-5 and IL-13 were higher than those of the control group; serum levels of Cor, NE, Ang-1 and Ang-2 were lower than those of the control group(P<0.05). Conclusion: Compared with conventional fentanyl PCIA, oxycodone PCIA after cervical cancer surgery has more advantages in analgesia and homeostasis.
引文
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2 Ida T,Goto T,Motoi T,et al.Surgical removal of an isolated femoral metastasis of uterine cervical squamous cell carcinoma:a case report and review of the literature[J].Eur J Gynaecol Oncol,2017,38(1):122-125.
3 Ma J,Li WY,Chai Q,et al.Correlation of P2RX7 gene rs1718125 polymorphism with postoperative fentanyl analgesia in patients with lung cancer[J].Medicine (Baltimore),2019,98(7):e14445.
4 杨晓平,黄东林,修玉芳.地佐辛复合舒芬太尼用于腹腔镜子宫内膜癌手术后静脉自控镇痛的效果探究[J].中国实用医药,2019,14(1):125-126.
5 Li Y,Dong HQ,Tan SB,et al.Effects of thoracic epidural anesthesia/analgesia on the stress response,pain relief,hospital stay,and treatment costs of patients with esophageal carcinoma undergoing thoracic surgery:A single-center,randomized controlled trial[J].Medicine (Baltimore),2019,98(7):e14362.
6 Li CZ,Peng JL,Hu R,et al.Safety and efficacy of ketamine versus ketamine-fentanyl-dexmedetomidine combination for anesthesia and analgesia in rats[J].Dose Response,2019,17(1):1559325819825902.
7 Ma J,Li WY,Chai Q,et al.Correlation of P2RX7 gene rs1718125 polymorphism with postoperative fentanyl analgesia in patients with lung cancer[J].Medicine (Baltimore),2019,98(7):e14445.
8 Han LC,Su YQ,Xiong HF,et al.Oxycodone versus sufentanil in adult patient-controlled intravenous analgesia after abdominal surgery:A prospective,randomized,double-blinded,multiple-center clinical trial[J].Medicine (Baltimore),2018,97(31):e11552.
9 苗杨,张金良,孙燕.盐酸羟考酮联合腹横肌平面阻滞用于经腹子宫肌瘤切除术术后镇痛效果观察[J].癌症进展,2019,17(1):90-92.
10 董雪山,李应宏,张宇杰,等.盐酸羟考酮缓释片联合华蟾素胶囊治疗癌性疼痛的临床观察[J].甘肃医药,2018,37(2):132-134.
11 Han LC,Su YQ,Xiong HF,et al.Oxycodone versus sufentanil in adult patient-controlled intravenous analgesia after abdominal surgery:A prospective,randomized,double-blinded,multiple-center clinical trial[J].Medicine (Baltimore),2018,97(31):e11552.
12 Friese MB,Nathan M,Culley DJ,et al.Isoflurane anesthesia impairs the expression of immune neuromodulators in the hippocampus of aged mice[J].PLoS One,2018,13(12):e0209283.
13 Cezar TLC,Martinez RM,Rocha CD,et al.Treatment with maresin 1,a docosahexaenoic acid-derived pro-resolution lipid,protects skin from inflammation and oxidative stress caused by UVB irradiation[J].Sci Rep,2019,9(1):3062.
14 Raouf M,Glogowski AJ,Bettinger JJ,et al.Serotonin-norepinephrine reuptake inhibitors and the influence of binding affinity (Ki) on analgesia[J].J Clin Pharm Ther,2017,42(4):513-517.
15 Yamaguchi K,Kumakura S,Murakami T,et al.Ketamine suppresses the substance P-induced production of IL-6 and IL-8 by human U373MG glioblastoma/astrocytoma cells[J].Int J Mol Med,2017,39(3):687-692.
16 Norris PC,Skulas-Ray AC,Riley I,et al.Identification of specialized pro-resolving mediator clusters from healthy adults after intravenous low-dose endotoxin and omega-3 supplementation:a methodological validation[J].Sci Rep,2018,8(1):18050.
17 Ying HF,Zhang WP,Zhou CL,et al.Effect of nerve root block guided by ultrasound on cervicogenic pain and its influence on immune function[J].J Biol Regul Homeost Agents,2018,32(5):1177-1183.
18 Hirotsu C,Pedroni MN,Berro LF,et al.Nicotine and sleep deprivation:impact on pain sensitivity and immune modulation in rats[J].Sci Rep,2018,8(1):13837.
19 Duh K,Funaro MG,DeGouveia W,et al.Crosstalk between the immune system and neural pathways in interstitial cystitis/bladder pain syndrome[J].Discov Med,2018,25(139):243-250.
20 Enns MW,Bernstein CN,Kroeker K,et al.The association of fatigue,pain,depression and anxiety with work and activity impairment in immune mediated inflammatory diseases[J].PLoS One,2018,13(6):e0198975.
21 秦革萍,杜睿,石小龙,等.盐酸右美托咪啶对老年肺癌患者术后应激与疼痛的影响[J].临床心身疾病杂志,2018,24(1):71-73,100.
2 Ida T,Goto T,Motoi T,et al.Surgical removal of an isolated femoral metastasis of uterine cervical squamous cell carcinoma:a case report and review of the literature[J].Eur J Gynaecol Oncol,2017,38(1):122-125.
3 Ma J,Li WY,Chai Q,et al.Correlation of P2RX7 gene rs1718125 polymorphism with postoperative fentanyl analgesia in patients with lung cancer[J].Medicine (Baltimore),2019,98(7):e14445.
4 杨晓平,黄东林,修玉芳.地佐辛复合舒芬太尼用于腹腔镜子宫内膜癌手术后静脉自控镇痛的效果探究[J].中国实用医药,2019,14(1):125-126.
5 Li Y,Dong HQ,Tan SB,et al.Effects of thoracic epidural anesthesia/analgesia on the stress response,pain relief,hospital stay,and treatment costs of patients with esophageal carcinoma undergoing thoracic surgery:A single-center,randomized controlled trial[J].Medicine (Baltimore),2019,98(7):e14362.
6 Li CZ,Peng JL,Hu R,et al.Safety and efficacy of ketamine versus ketamine-fentanyl-dexmedetomidine combination for anesthesia and analgesia in rats[J].Dose Response,2019,17(1):1559325819825902.
7 Ma J,Li WY,Chai Q,et al.Correlation of P2RX7 gene rs1718125 polymorphism with postoperative fentanyl analgesia in patients with lung cancer[J].Medicine (Baltimore),2019,98(7):e14445.
8 Han LC,Su YQ,Xiong HF,et al.Oxycodone versus sufentanil in adult patient-controlled intravenous analgesia after abdominal surgery:A prospective,randomized,double-blinded,multiple-center clinical trial[J].Medicine (Baltimore),2018,97(31):e11552.
9 苗杨,张金良,孙燕.盐酸羟考酮联合腹横肌平面阻滞用于经腹子宫肌瘤切除术术后镇痛效果观察[J].癌症进展,2019,17(1):90-92.
10 董雪山,李应宏,张宇杰,等.盐酸羟考酮缓释片联合华蟾素胶囊治疗癌性疼痛的临床观察[J].甘肃医药,2018,37(2):132-134.
11 Han LC,Su YQ,Xiong HF,et al.Oxycodone versus sufentanil in adult patient-controlled intravenous analgesia after abdominal surgery:A prospective,randomized,double-blinded,multiple-center clinical trial[J].Medicine (Baltimore),2018,97(31):e11552.
12 Friese MB,Nathan M,Culley DJ,et al.Isoflurane anesthesia impairs the expression of immune neuromodulators in the hippocampus of aged mice[J].PLoS One,2018,13(12):e0209283.
13 Cezar TLC,Martinez RM,Rocha CD,et al.Treatment with maresin 1,a docosahexaenoic acid-derived pro-resolution lipid,protects skin from inflammation and oxidative stress caused by UVB irradiation[J].Sci Rep,2019,9(1):3062.
14 Raouf M,Glogowski AJ,Bettinger JJ,et al.Serotonin-norepinephrine reuptake inhibitors and the influence of binding affinity (Ki) on analgesia[J].J Clin Pharm Ther,2017,42(4):513-517.
15 Yamaguchi K,Kumakura S,Murakami T,et al.Ketamine suppresses the substance P-induced production of IL-6 and IL-8 by human U373MG glioblastoma/astrocytoma cells[J].Int J Mol Med,2017,39(3):687-692.
16 Norris PC,Skulas-Ray AC,Riley I,et al.Identification of specialized pro-resolving mediator clusters from healthy adults after intravenous low-dose endotoxin and omega-3 supplementation:a methodological validation[J].Sci Rep,2018,8(1):18050.
17 Ying HF,Zhang WP,Zhou CL,et al.Effect of nerve root block guided by ultrasound on cervicogenic pain and its influence on immune function[J].J Biol Regul Homeost Agents,2018,32(5):1177-1183.
18 Hirotsu C,Pedroni MN,Berro LF,et al.Nicotine and sleep deprivation:impact on pain sensitivity and immune modulation in rats[J].Sci Rep,2018,8(1):13837.
19 Duh K,Funaro MG,DeGouveia W,et al.Crosstalk between the immune system and neural pathways in interstitial cystitis/bladder pain syndrome[J].Discov Med,2018,25(139):243-250.
20 Enns MW,Bernstein CN,Kroeker K,et al.The association of fatigue,pain,depression and anxiety with work and activity impairment in immune mediated inflammatory diseases[J].PLoS One,2018,13(6):e0198975.
21 秦革萍,杜睿,石小龙,等.盐酸右美托咪啶对老年肺癌患者术后应激与疼痛的影响[J].临床心身疾病杂志,2018,24(1):71-73,100.