| 陈新生,饶云霞.地佐辛联合舒芬太尼术后镇痛对胸段食管鳞癌根治术病人睡眠质量及血清脑源性神经营养因子、去甲肾上腺素、 5-羟色胺水平的影响[J].安徽医药,2021,25(6):1242-1245. |
| 地佐辛联合舒芬太尼术后镇痛对胸段食管鳞癌根治术病人睡眠质量及血清脑源性神经营养因子、去甲肾上腺素、 5-羟色胺水平的影响 |
| Effects of postoperative analgesia with dezocine and sufentanil on sleep quality and levels of serum BDNF, NE and 5-HT in patients undergoing radical resection of thoracic esophageal squamous cell carcinoma |
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| DOI：10.3969/j.issn.1009-6469.2021.06.045 |
| 中文关键词: 安定镇痛 疼痛，手术后 食管切除术 地佐辛 舒芬太尼 睡眠质量 脑源性神经营养因子 去甲肾上腺素 5-羟色胺 |
| 英文关键词: Neuroleptanalgesia Pain, postoperative Esophagectomy Dezocine Sufentanil Sleep quality BDNF |
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| 中文摘要: |
| 目的探究地佐辛联合舒芬太尼术后镇痛对胸段食管鳞癌根治术病人睡眠质量及血清 BDNF、NE、5-羟色胺水平的影响。方法选取于 2013年 12月至 2015年 3月来天门市第一人民医院接受治疗的 100例胸段食管鳞癌病人作为研究对象，均采用相同手术方式，按随机数字表法将其分为对照组 50例和试验组 50例。对照组于术后采用舒芬太尼( 3 μg/kg)治疗， 100 μg稀释到 100 mL生理盐水中；试验组在对照组基础上给予地佐辛( 0.4 mg/kg)治疗，用生理盐水将其稀释到 100 mL。两组均自动镇痛泵输注量 2 mL/h，锁定 15 min，连续治疗 7d。通过酶联免疫吸附测定检测血清脑源性神经营养因子( BDNF)、去甲肾上腺素( NE)、 5-羟色胺的表达；通过全自动生化分析仪测定降钙素原、 C反应蛋白( CRP)、白细胞介素 -6(IL-6)水平；分别采用疼痛视觉模拟评分( VAS)和 Ramsay镇静评分评价镇痛镇静效果；通过匹兹堡睡眠质量指数(PSQI)评价睡眠质量；分别采用汉密尔顿焦虑量表( HAMA)评分和汉密尔顿抑郁量表( HAMD)评分评价负面情绪。结果治疗前，两组胸段食管鳞癌病人血清 BDNF、NE、5-羟色胺、降钙素原、 CRP、IL-6、VAS、Ramsay、HAMA、HAMD、PSQI比较，差异无统计学意义( P>0.05)；治疗后，试验组和对照组胸段食管鳞癌病人血清 BDNF水平均高于治疗前，试验组 BDNF(23.14±6.79)μg/L高于对照组( 16.87±5.57)μg/L(P <0.05)；治疗后，试验组和对照组胸段食管鳞癌病人血清 5-羟色胺、 NE、降钙素原、 CRP、IL-6水平及 VAS、HAMA、HAMD、PSQI评分均低于治疗前，试验组低于对照组［NE(219.14±51.86)μg/L比( 240.53±55.52)μg/L，5-羟色胺( 0.16±0.05)μmol/L比( 0.21±0.07)μmol/L，P<0.05］；而两组 Ramsay评分均高于治疗前，试验组高于对照组。结论地佐辛联合舒芬太尼可有效抑制胸段食管鳞癌病人术后疼痛介质释放，增高血清 BDNF水平，降低血清 NE、5-羟色胺水平，缓解病人疼痛症状，抑制炎性反应，并对抑制负面情绪、提高病人睡眠质量有一定作用，有利于病人术后恢复，具有一定推广价值。 |
| 英文摘要: |
| Objective To explore the effects of postoperative analgesia with dezocine and sufentanil on sleep quality and levels of serum BDNF, NE and 5-HT in patients undergoing radical resection of thoracic esophageal squamous cell carcinoma.Methods A total of 100 patients with thoracic esophageal squamous cell carcinoma admitted to Tianmen First People′s Hospital from December 2013to March 2015 were selected as the study subjects. According to the method of random number table, they were divided into controlgroup (50 cases) and experimental group (50 cases). The control group was treated with sufentanil (3 μg/kg) and diluted 100 μg to 100normal saline. The experimental group was treated with dizosin (0.4 mg/kg) on the basis of the control group and diluted to 100 mL. Twogroups of automatic analgesia pump infusion volume 2 mL/h, locked 15 min, continuous treatment 7 d. The expressions of brain-derived neurotrophic factor (BDNF), norepinephrine (NE) and serotonin (5-HT) in serum were detected by enzyme-linked immunosorbent assay (ELISA), the levels of procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) were measured by automatic biochemicalanalyzer, pain visual analogue scale (VAS) and Ramsay sedation score were used to evaluate the analgesic and sedative effects, sleepquality was evaluated by Pittsburgh Sleep Quality Index (PSQI), and negative emotions were assessed by Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD). Results Before treatment, there were no sigenificant differences between the two groups in serum BDNF, NE, 5-hydroxytryptamine, procalcitonin, CRP, IL-6, VAS, Ramsay, HAMA, HAMD and PSQI (P > 0.05). Aftertreatment,the serum BDNF levels of patients with thoracic esophageal squamous cell carcinoma in experimental group and controlgroup were higher than those before treatment,the BDNF of the experimental group was (23.14±6.79) μg/L higher than that of the control group (16.87±5.57) μg/L (P<0.05). After treatment,the levels of serum 5-hydroxytryptamine, NE, procalcitonin, CRP, IL-6 and scores of VAS, HAMA, HAMD and PSQI in patients with thoracic esophageal squamous cell carcinoma were lower than those beforetreatment,the NE level in the experimental group (219.14±51.86) μg/L was lower than that in the control group (240.53±55.52)μg/L,the 5-hydroxytryptamine (0.16±0.05) μmol/L in the experimental group was lower than that in the control group (0.21±0.07) μmol/L (P <0.05), and the Ramsay scores of of the two groups were higher than that of the control group before treatment.Conclusion Dezocine combined with sufentanil can effectively inhibit the release of pain mediators in patients with thoracic esophageal squamous cell carcinoma after operation, increase the level of serum BDNF, reduce the levels of serum NE and 5-hydroxytryptamine, relieve pain symptoms of patients, suppress inflammatory reaction, and also has a certain effect on suppressing negative emotions and improving patients′sleep quality, which is beneficial to the postoperative recovery of patients and has certain popularization value. |
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