【摘要】：目的探討嗎啡混合布比卡因創(chuàng)面噴灑用于預(yù)防乳腺癌切除術(shù)后疼痛綜合征(PMPS)的效果及其對免疫功能的影響。方法擇期行乳腺癌改良根治術(shù)的患者90例,采用隨機(jī)數(shù)字表法隨機(jī)分為對照組(C組)、布比卡因組(B組)和嗎啡混合布比卡因組(MB組),每組30例,縫皮前即刻分別用鹽水、布比卡因或嗎啡/布比卡因混合液均勻噴灑于創(chuàng)面,保持藥液在創(chuàng)面30 min后打開引流管。記錄術(shù)后6、12、24和48 h靜態(tài)和動態(tài)VAS、術(shù)后48 h內(nèi)靜脈自控鎮(zhèn)痛(PCIA)藥液消耗量、舒芬太尼的使用率和用量以及不良反應(yīng)的發(fā)生情況,并于術(shù)前1 h和術(shù)后24 h抽取靜脈血測定細(xì)胞因子白細(xì)胞介素(IL)-2、γ干擾素(INF-γ)和IL-10的濃度。術(shù)后1、3個月以利茲神經(jīng)病理性疼痛癥狀與體征評價量表(LANSS)測定患者是否患有PMPS。結(jié)果與C組比較,B組各時點靜態(tài)和動態(tài)VAS降低(P0.05);與B組比較,MB組各時點靜態(tài)和動態(tài)VAS降低(P0.05)。與C組比較,B組PICA藥液的消耗量、舒芬太尼的使用率和用量均降低(P0.05);與B組比較,MB組PICA藥液的消耗量、舒芬太尼的使用率和用量均降低(P0.05)。3組間不良反應(yīng)的發(fā)生率差異無統(tǒng)計學(xué)意義(P0.05)。與C組比較,B組術(shù)后1、3個月的LANSS評分和PMPS發(fā)生率均降低(P0.05);與B組比較,MB組術(shù)后1、3個月的LANSS評分和PMPS發(fā)生率均降低(P0.05)。3組間手術(shù)前后血清細(xì)胞因子的濃度差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論嗎啡混合布比卡因創(chuàng)面噴灑可減少PMPS的發(fā)生,且對免疫功能無影響。
[Abstract]:Objective to investigate the effect of morphine combined bupivacaine spray on the prevention of postoperative pain syndrome (PMPS) after breast cancer resection and its effect on immune function. Methods 90 patients with breast cancer undergoing modified radical mastectomy were randomly divided into control group (group C), bupivacaine group (group B) and morphine mixed bupivacaine group (MB group). Immediately before suture, brine, bupivacaine or morphine / bupivacaine were sprayed evenly on the wound, and the drainage tube was opened after 30 min. The consumption of intravenous analgesic (PCIA), the usage and dosage of sufentanil and the occurrence of adverse reactions were recorded at 24 and 48 hours after operation by static and dynamic VAS,. The concentrations of cytokines interleukin (IL) 2, interferon 緯 (INF- 緯) and IL-10 were measured 1 hour before operation and 24 hours after operation. 1 and 3 months after operation, PMPS. was measured with the Leeds Neuropathic pain Evaluation scale (LANSS). Results compared with group C, the static and dynamic VAS of group B was lower than that of group C (P0.05), and the static and dynamic VAS of group MB was lower than that of group B (P0.05). Compared with group C, the consumption of PICA, the utilization rate and dosage of sufentanil in group B were decreased (P0.05). Compared with group B, the consumption of PICA, the usage and dosage of sufentanil in MB group were decreased (P0.05). There was no significant difference in the incidence of adverse reactions among the three groups (P0.05). Compared with group C, the LANSS score and the incidence of PMPS in group B were significantly lower than those in group C 1 and 3 months after operation (P0.05). Compared with group B, the LANSS score and the incidence of PMPS decreased in MB group 1 and 3 months after operation (P0.05). There was no significant difference in serum cytokine levels between the three groups before and after operation (P0.05). Conclusion morphine combined with bupivacaine can reduce the incidence of PMPS and has no effect on immune function.
【作者單位】： 河北醫(yī)科大學(xué)第三醫(yī)院麻醉科;哈勵遜國際和平醫(yī)院麻醉科;河北醫(yī)科大學(xué)基礎(chǔ)醫(yī)學(xué)院法醫(yī)系;
【分類號】：R614;R737.9

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