【摘要】 目的观察咪唑安定联合地佐辛对围术期胃肠道肿瘤患者的镇痛疗效及安全性。方法将74例胃肠道肿瘤患者随机分为对照组37例与试验组37例。对照组予以静脉注射咪唑安定0.06 mg·kg^-1+芬太尼1.0μg·kg^-1;试验组予以静脉注射咪唑安定0.06 mg·kg^-1+地佐辛0.1 mg·kg^-1。麻醉效果满意后,由同一医师完成胃肠道肿瘤根治术。比较2组患者的免疫功能、炎性因子,以及药物不良反应的发生情况。结果术后4 h,试验组和对照组的NK细胞百分比分别为（14.39±2.28）%,（12.99±1.84）%;CD₃⁺分别为（52.94±4.19）%,（48.15±4.36）%;CD₄⁺分别为（27.64±2.15）%,（24.71±2.08）%;CD₄⁺/CD₈⁺分别为（1.04±0.12）,（0.96±0.15）;白细胞介素-2（IL-2）分别为（72.92±8.32）,（65.71±8.25）pg·mL^-1;C反应蛋白分别为（48.26±9.14）,（83.91±11.96）mg·L-1;肿瘤坏死因子-α分别为（26.81±6.30）,（29.94±5.71）pg·mL^-1;IL-6分别为（45.31±5.08）,（66.95±7.13）pg·mL^-1,差异均有统计学意义（P<0.05）。试验组和对照组轻度不适分别为8.11%（3/37例）,27.03%（10/37例）;呼吸抑制分别为10.81%（4/37例）,62.16%（23/37例）;恶心呕吐发生率分别为5.41%（2/37例）,35.14%（13/37例）,差异均有统计学意义（P<0.05）。试验组和对照组完全性遗忘发生率分别为78.38%（29/37例）,83.78%（31/37例）,差异无统计学意义（P>0.05）。结论咪唑安定联合地佐辛方案与咪唑安定联合芬太尼方案对围术期胃肠道肿瘤患者的镇痛疗效相当,但前者能有效地促进患者术后免疫功能的恢复,控制炎症反应,且安全性较好。更多还原

【Abstract】 Objective To observe the analgesic effect and safety of midazolam combined with dezocine on perioperative gastrointestinal cancer patients. Methods Seventy- four patients with gastrointestinal cancer were randomly divided into control group（ n = 37） and treatment group（ n = 37）. Control group was treated with midazolam 0. 06 mg·kg^-1+fentanyl 1. 0 μg · kg^-1. Treatment group was given midazolam 0. 06mg·kg^-1+ dezocine 0. 1 mg·kg^-1. After satisfactory anesthesia,the radical surgery for gastrointestinal tumors were completed by the same physician. The immune functions,inflammatory factors and adverse drug reactions were compared between two groups. Results 4 h after operation,the main indexes in treatment and control groups were compared:the percentage of NK cells were（ 14. 39 ± 2. 28） %,（ 12. 99 ± 1. 84） %; CD₃⁺were（ 52. 94 ± 4. 19） %,（ 48. 15 ± 4. 36） %; CD₄⁺were（ 27. 64 ± 2. 15） %,（ 24. 71 ± 2. 08） %; CD₄⁺/ CD₈⁺were（ 1. 04 ± 0. 12）,（ 0. 96 ± 0. 15）; interleukin- 2（ IL- 2） were（ 72. 92 ± 8. 32）,（ 65. 71 ± 8. 25） pg·m L^-1; C- reactive protein were（ 48. 26 ± 9. 14）,（ 83. 91 ± 11. 96） mg·L^-1; tumor necrosis factor- alpha were（ 26. 81 ± 6. 30）,（ 29. 94 ± 5. 71）pg·m L^-1; IL- 6 were（ 45. 31 ± 5. 08）,（ 66. 95 ± 7. 13） pg · m L^-1,with statistically significant difference（ P < 0. 05）. In the treatment and control groups,the mild discomfort were 8. 11%（ 3/37 cases）,27. 03%（ 10/37 cases）;respiratory inhibition were 10. 81%（ 4 /37 cases）,62. 16%（ 23 /37 cases）; incidences of nausea and vomiting were 5. 41%（ 2/37 cases）,35. 14%（ 13/37 cases）,with significant difference（ P <0. 05）. The incidence of complete amnesia in the treatment and the control groups were 78. 38%（ 29 /37 cases）,83. 78%（ 31 /37 cases）,without statistically significant difference（ P > 0. 05）. Conclusion Midazolam combined with dezocine has a good effect and safe for the treatment of patients with gastrointestinal cancer surrounding operative analgesia,which can promote the recovery of immune function after surgery and control the inflammatory response.更多还原