肝癌切除术后应用右美托咪定复合舒芬太尼和布托啡诺静脉自控镇痛效果研究*

doi:10.3969/j.issn.1672-5069.2025.02.027

摘要/Abstract

摘要： 目的观察在肝癌切除术后应用右美托咪定复合舒芬太尼和布托啡诺静脉自控镇痛的效果。方法 2020年1月～2023年12月我院收治的原发性肝癌(PLC)患者72例,被随机分为对照组36例和观察组36例,均接受腹腔镜肝癌切除术(LH)治疗。术后,在对照组应用舒芬太尼和布托啡诺经静脉自控镇痛泵输入,在观察组应用右美托咪定复合舒芬太尼和布托啡诺经静脉自控镇痛泵输入镇痛。采用疼痛视觉模拟评分(VAS)评估疼痛,采用放射免疫分析法检测血清神经肽Y(NPY)、P物质(SP)和5-羟色胺(5-HT)水平,采用ELISA法检测血清皮质醇(Cor)、儿茶酚胺(CA)和促肾上腺皮质激素(ACTH)水平。结果观察组术后自主呼吸恢复时间和苏醒时间分别为(16.7±2.2)min和(19.3±2.4)min,显著短于对照组【分别为(21.2±2.7)min和(23.8±3.1)min,P＜0.05】;在术后24 h和48 h,观察组VAS评分分别为(1.6±0.3)分和(1.0±0.2)分,显著低于对照组【分别为(2.1±0.4)分和(1.9±0.3)分,P＜0.05】;在术后24 h,观察组血清NPY、SP和5-HT水平分别为(41.8±8.6)pg/mL、(52.5±10.4)pg/mL和(0.4±0.1)μmol/L,均显著低于对照组【分别为(54.4±10.7)pg/mL、(79.5±13.8)pg/mL和(0.5±0.1)μmol/L,P＜0.05】;观察组血清Cor、CA和ACTH水平分别为(211.5±29.0)nmol/L、(216.6±29.7)pg/mL和(6.6±1.3)pg/mL,均显著低于对照组【分别为(265.6±25.8)nmol/L、(240.7±26.3)pg/mL和(8.4±1.5)pg/mL,P＜0.05】。结论在LH术后,应用右美托咪定复合舒芬太尼和布托啡诺自控镇痛效果好,可能与抑制了机体应激反应有关。

关键词: 原发性肝癌, 腹腔镜肝癌切除术, 右美托咪定, 舒芬太尼, 布托啡诺, 镇痛, 应激反应

Abstract: Objective The purpose of this study was to investigate efficacy of self-controlled intravenous analgesia of dexmedetomidine and sufentanil and butorphanol combination in patients with primary liver cancer (PLC) after laparoscopic hepatectomy (LH). Methods 72 patients with PLC were enrolled in our hospital between January 2020 and December 2023, and all underwent LH for resection of liver cancer. For post-operational analgesia after surgery, patients were randomly divided into control (n=36) and observation (n=36) groups, receiving intravenous pumping of sufentanil and butorphanol or sufentanil, butorphanol and dexmedetomidine combination by self-controlled way. Body pain was evaluated by visual analogue scale (VAS). Serum neuropeptide Y (NPY), substance P (SP) and 5-hydroxytryptamine (5-HT) levels were assayed by RIA, and serum cortisol (Cor), catecholamine (CA) and adrenocorticotropic hormone (ACTH levels were detected by ELISA. Results Recovery of autonomous respiration and waking in the observation group(16.7±2.2)min and (19.3±2.4)min, both much shorter than [(21.2±2.7)min and (23.8±3.1)min, respectively, P＜0.05] in the control; by 24 hours and 48 hours after operation, VAS scores in the observation were (1.6±0.3)points and (1.0±0.2)points, both significantly lower than [(2.1±0.4)points and (1.9±0.3)points, P＜0.05] in the control; by 24 hours after surgery, serum NPY, SP and 5-HT levels in the observation were (41.8±8.6)pg/mL, (52.5±10.4)pg/mL and (0.4±0.1)μmol/L, all significantly lower than [(54.4±10.7)pg/mL, (79.5±13.8)pg/mL and (0.5±0.1)μmol/L, respectively, P＜0.05] in the control; serum Cor, CA and ACTH levels were (211.5±29.0)nmol/L, (216.6±29.7)pg/mL and (6.6±1.3)pg/mL, all much lower than [(265.6±25.8)nmol/L, (240.7±26.3)pg/mL and (8.4±1.5)pg/mL, respectively, P＜0.05] in the control group. Conclusion The application of dexmedetomidine combined with sufentanil and butorphanol for analgesia in patients with PLC after LH have a perfect efficacy, which might be related to inhibition of stress reaction.

Key words: Hepatoma, Laparoscopic hepatectomy, Dexmedetomidine, Sufentanil, Butorphanol, Analgesia, Stress reaction

张华, 钟焕辉, 旷艳春, 顾晖, 洪勇, 徐化交, 陈勉, 刘海生. 肝癌切除术后应用右美托咪定复合舒芬太尼和布托啡诺静脉自控镇痛效果研究^*[J]. 实用肝脏病杂志, 2025, 28(2): 266-269.

Zhang Hua, Zhong Huanhui, Kuang Yanchun, et al. Patient-controlled intravenous analgesia of dexmedetomidine and sufentanil and butorphanol combination in patients with primary liver cancer after laparoscopic hepatectomy[J]. Journal of Practical Hepatology, 2025, 28(2): 266-269.

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肝癌切除术后应用右美托咪定复合舒芬太尼和布托啡诺静脉自控镇痛效果研究^*

Patient-controlled intravenous analgesia of dexmedetomidine and sufentanil and butorphanol combination in patients with primary liver cancer after laparoscopic hepatectomy

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