不同镇痛方式对老年胃癌患者术后认知功能及炎性因子表达的影响

摘要/Abstract

摘要： 目的探究静脉自控镇痛（PCIA）和经硬膜外自控镇痛（PCEA）对老年患者胃癌术后认知功能及炎性因子表达的影响。方法选取2017年4月~2020年4月在河南大学第一附属医院行胃癌手术的114例老年患者作为研究对象,按随机数字表法随机分为PCIA组（n=57）和PCEA组（n=57）,记录不同时点镇痛效果及认知功能,并分析术前、术后炎性因子水平。结果重复测量数据方差分析结果显示,2组患者视觉模拟评分（VAS）、简易智力状态检查量表（MMSE）评分均随时间因素、组别因素以及时间和组别的交互作用变化,差异均有统计学意义（F_时点=5615.485、13314.578,P<0.05;F_交互=315.107、331.138,P<0.05）;且同时点比较,PCEA组VAS评分均显著低于PCIA组（P<0.05）,MMSE评分均显著高于PCIA组（P<0.05）。炎性因子比较,2组患者术后24h肿瘤坏死因子α（TNF-α）、血清C反应蛋白（CRP）以及白细胞介素-6（IL-6）水平均显著高于术前（P<0.05）,术后24h组间比较,PCEA组TNF-α、CRP、IL-6水平均显著低于PCIA组（P<0.05）。结论与PCIA相比,PCEA镇痛效果更明显,而且能减少认知功能损害并降低应激反应相关的炎性因子表达。

关键词: 静脉自控镇痛, 硬膜外自控镇痛, 镇痛效果, 认知功能, 炎性因子

Abstract: Objective To investigate the effects of PCIA and PCEA on postoperative analgesic effect, cognitive function and inflammatory factor expression in elderly patients with gastric cancer. Methods Select 114 elderly patients who underwent gastric cancer surgery in the First Affiliated Hospital of Henan University from April 2017 to April 2020 as the research objects. They were randomly divided into PCIA group (n=57) and PCEA group (n=57) according to the random number table method. The analgesic effect and cognitive function at different time points were analyzed, and the levels of inflammatory factors before and after operation were recorded. Results According to the results of the analysis of variance of repeated measurement data,, the VAS and MMSE scores of the two groups of patients were all statistically significant in terms of time factor, group factor, and the interaction between time and group（F_time=5615.485、13314.578,P<0.05;F_group=315.107、331.138,P<0.05）. At the same time-point, VAS scores in the PCEA group were significantly lower than those in the PCIA group (P<0.05), and MMSE scores were significantly higher than those in the PCIA group (P<0.05). The levels of TNF-α, CRP and IL-6 were significantly higher in 2 groups 24h after surgery than those in the preoperative group(P<0.05). The levels of TNF-α, CRP and IL-6 in the PCEA group were significantly lower than those in the PCIA group 24h after surgery(P<0.05). Conclusion Compared with PCIA, PCEA has a more significant analgesic effect, while reducing cognitive impairment and the expression of inflammatory factors related to stress response.

Key words: PCIA, PCEA, analgesic effect, cognitive function, inflammatory cytokines

中图分类号:

R735.2

祁向雯. 不同镇痛方式对老年胃癌患者术后认知功能及炎性因子表达的影响[J]. 承德医学院学报, 2022, 39(1): 25-29.

QI Xiang-wen. Effects of Different Analgesic Methods on Postoperative Cognitive Function and Inflammatory Factor Expression in Elderly Patients with Gastric Cancer[J]. Journal of Chengde Medical University, 2022, 39(1): 25-29.

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