手术体积描记指数指导镇痛在老年结肠癌患者手术中的应用研究

A study of application of surgical pleth index to guide analgesia in elderly colon cancer patients undergoing surgery

中文关键词: 老年  结肠癌  手术体积描记指数  疼痛评分  炎性因子

英文关键词: elderly  colon cancer  surgical pleth index  pain score  inflammatory factor

中文摘要:

      目的 探讨手术体积描记指数(surgical pleth index,SPI)是否能够指导镇痛药物在老年全麻患者中的精准使用.方法 选择择期行结肠癌手术的老年患者60 例,所有入选患者根据SPSS产生的随机号分组,对照组(C组)根据麻醉医师经验使用舒芬太尼,试验组(T组)在SPI指导下使用舒芬太尼,每组 30 例.记录 2 组的一般情况与入室时、气管插管、手术开始、手术结束及气管拔管后5 min的MBP、HR;记录2 组的手术时长与气管导管拔除时长;记录2 组的术中与PACU期间舒芬太尼用量、能够清醒交流时和出PACU时的疼痛数字评分(采用NRS评估)并检测手术前后血清IL-6、IL-10 水平.结果 2 组的一般情况、手术时长及拔管时长无统计学差异(P＞0.05);2 组患者各时间点MBP、HR差异均无统计学意义(P＞0.05);T组舒芬太尼用量术中多于C组、在PACU时少于C组(P＜0.05),且T组的2 次NRS评分均低于C组(P＜0.05);2 组术前血清IL-6 与IL-10 水平差异均无统计学意义(P＞0.05),术毕差异有统计学意义(P＜0.05);与同组术前相比,术毕2 组血清IL-6 水平均有升高,但C组差异有统计学意义(P＜0.05),T组差异无统计学意义(P＞0.05);与同组术前相比,术毕 C 组血清 IL-10 水平下降,而 T 组上升,且差异均有统计学意义(P＜0.05).结论 在结肠癌手术中,SPI能够较好地指导镇痛药物在老年全麻患者中的精准使用,提供适当的镇痛水平,降低术中应激反应和苏醒期间的不良并发症.

英文摘要:

      Objective To explore whether surgical pleth index(SPI)can guide the precise use of analgesic drugs in elderly patients under general anesthesia.Methods A total of 60 elderly patients scheduled for elective colon cancer surgery were selected and grouped according to random numbers generated by SPSS,with 30 cases in each group.The control group(group C)used sufentanil based on the experience of anesthesiologists,while the experimental group(group T)used sufen-tanil under the guidance of SPI.The general conditions of the two groups were collected.MBP and HR at the time of admission to the operating room,tracheal intubation,the beginning of the operation,the end of the operation,and 5 min after extubation of the two groups were recorded.The operation time,extubation time,and dosage of sufentanil during surgery and PACU of the two groups were recorded.The numerical pain scores[assessed by Numerical Rating Scale(NRS)]of the two groups of patients were also recorded when they were able to communicate awake and when they discharged from PACU.The levels of serum IL-6 and IL-10 were detected before and after operation.Results There were no differences in the general condition,operation time and extubation time between the two groups(P＞0.05).There was no significant difference in MBP and HR between the two groups at each time point(P＞0.05).The dosage of sufentanil in the group T was more than that in the group C during the operation and less than that in the group C during PACU(P＜0.05),and the two NRS scores of the group T were lower than those of the group C(P＜0.05).The difference in the levels of serum IL-6 and IL-10 between the two groups be-fore operation was not statistically significant(P＞0.05),while the differences after operation were statistically significant(P＜0.05).Compared with the same group before operation,serum IL-6 level in both groups increased after operation,but the difference in the group C was statistically significant(P＜0.05),while the difference in group T was not statistically signif-icant(P＞0.05).Compared with the same group before operation,the serum IL-10 level in the group C decreased after opera-tion,but increased in the group T,and the difference was statistically significant(P＜0.05).Conclusion SPI can effectively guide the precise use of analgesics in elderly patients under general anesthesia during colon cancer surgery,provide appropriate analgesia levels,and reduce intraoperative stress reactions and adverse complications during recovery.