才莹 张虹 崔轮盟 刘艳艳 杨蕊 谢凤杰

【摘要】 目的：探討静脉注射舒芬太尼联合足三里穴位注射利多卡因对ICU腹部术后患者的镇痛效果、胃肠功能、免疫功能及炎性因子的影响。方法：选取2019年6月-2020年1月牡丹江医学院附属红旗医院ICU腹部术后患者60例，按随机数字表法分为A、B、C组，每组20例。A组给予舒芬太尼静脉泵注;B组给予舒芬太尼静脉泵注联合足三里穴位注射利多卡因;C组给予舒芬太尼静脉泵注联合足三里穴位注射生理盐水。比较三组镇痛即刻、2、6、12、24、48 h舒芬太尼使用剂量，IL-6、TNF-α、CD4+、CD8+、CD4+/CD8+水平;比较三组镇痛48 h后胃肠道功能疗效及不良反应发生情况。结果：B组镇痛2、6、12、24 h舒芬太尼使用剂量均低于A、C组（P<0.05）。B组胃肠道功能治疗总有效率高于A组，差异有统计学意义（P<0.05）。镇痛2、6、12、24、48 h，A组IL-6水平均高于B、C组（P<0.05）;镇痛6、12、24、48 h，B组IL-6水平均低于C组（P<0.05）。镇痛2、6、12、24、48 h，A组TNF-α水平均高于B、C组，且C组高于B组（P<0.05）。镇痛24、48 h，三组CD4+、CD4+/CD8+均高于镇痛即刻（P<0.05）;镇痛24、48 h，B组CD4+/CD8+均高于A组（P<0.05）。B组恶心呕吐、低血压发生率均低于A组（P<0.05）。结论：舒芬太尼联合足三里穴位注射利多卡因对ICU腹部术后患者镇痛效果确切，可减少阿片类药物用量，改善胃肠道功能，提高机体免疫力及减少炎性因子释放。

【关键词】 舒芬太尼 腹部手术 穴位注射 多模式镇痛 胃肠功能 免疫功能

Clinical Study of Sufentanil Combined with Acupoint Injection for Analgesic Treatment of Severe Abdominal Postoperative Patients/CAI Ying， ZHANG Hong， CUI Lunmeng， LIU Yanyan， YANG Rui， XIE Fengjie. //Medical Innovation of China， 2021， 18（14）： -133

[Abstract] Objective： To explore the effect of intravenous injection of Sufentanil combined with acupoint injection of Lidocaine at Zusanli point on the analgesic effect， gastrointestinal function， immune function and inflammatory factors of ICU patients after abdominal surgery. Method： A total of 60 patients abdominal surgery in the ICU of Hongqi Hospital Affiliated to Mudanjiang Medical College from June 2019 to January 2020 were selected. They were divided into group A， B and C according to random number table method， with 20 patients in each group. Group A was given Sufentanil intravenous pump; group B was given Sufentanil intravenous pump combined with Lidocaine at Zusanli; group C was given Sufentanil intravenous pump with Zusanli injected normal saline. The doses of Sufentanil and the levels of IL-6， TNF-α， CD4+， CD8+ and CD4+/CD8+ were compared among the three groups at the time of analgesic immediately， 2， 6， 12， 24 and 48 h. The effect of gastrointestinal function and the incidence of adverse reactions were compared among the three groups after 48 h analgesia. Result： The doses of Sufentanil at analgesic 2， 6， 12 and 24 h in group B were lower than those in group A and C （P<0.05）. The total effective rate of gastrointestinal function treatment in group B was higher than that in group A， the difference was statistically significant （P<0.05）. Analgesic 2， 6， 12， 24 and 48 h， IL-6 levels in group A were higher than those in groups B and C （P<0.05）. The levels of IL-6 in group B were lower than those in group C at analgesic 6， 12， 24 and 48 h （P<0.05）. Analgesic 2， 6， 12， 24 and 48 h， the levels of TNF-α in group A were higher than those in group B and C， and those in group C were higher than those in group B （P<0.05）. Analgesic 24 and 48 h， CD4+ and CD4+/CD8+ in three groups were higher than those analgesic immediately （P<0.05）; analgesic 24 and 48 h， CD4+/CD8+ in group B were higher than those in group A （P<0.05）. The incidences of nausea， vomiting and hypotension in group B were lower than those in group A （P<0.05）. Conclusion： Sufentanil combined with injection of Lidocaine at Zusanli acupoint has a definite analgesic effect on ICU patients after abdominal surgery， it can reduce the amount of opioids， improve gastrointestinal function， improve immunity and reduce the release of inflammatory factors.

[Key words] Sufentanil Abdominal surgery Acupoint injection Multimodal analgesia Gastrointestinal function Immune function

First-authors address： Mudanjiang Medical University， Mudanjiang 157011， China

doi：10.3969/j.issn.1674-4985.2021.14.031

在急性疼痛领域，医学界面临的疼痛管理挑战三个方面之一即为外科术后的疼痛管理，重症腹部术后患者常因外科手术的伤害性刺激、神经损伤、组织局部缺血等因素引起术后疼痛，其往往发展快，疼痛感剧烈[1-2]。与此同时ICU腹部术后患者还遭受侵入性医疗操作（如深静脉置管、气管插管、尿管、引流管等）、不能与外界正常交流、睡眠剥夺、不能进行早期活动等痛苦。因此镇痛镇静药物被广泛用于ICU患者的治疗中，从而减轻患者应激发应，提高舒适度[3]。舒芬太尼作为一种强效阿片类药物，因其镇痛起效快，强度大，常用于ICU术后患者的疼痛治疗，但其不良反应，如呼吸循环抑制、易成瘾、尿潴留、胃肠道功能紊乱等，限制了重症腹部术后患者的康复[4]。……