Gong Qing-an, Li Man
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2015 Jun;35(6):668-72.
To explore the effect of lappaconitine on patient-controlled intravenous analgesia (PCIA) and serum complement 3 and 4 (C3 and C4) levels of cancer patients undergoing rectum surgery.
Totally 60 patients, who were scheduled for rectum carcinoma surgery, were recruited to the study and assigned in 3 groups, the blank control group, the tramadol group, and the lappaconitine group, 20 in each group. Lappaconitine (8 mg) was intravenously dripped to patients in the lappaconitine group 30 min before ending the operation. PCIA started as soon as the end of the surgery and the total dose of lappaconitine was 36 mg. Patients of the tramadol group were treated with tramadol (100 mg) intravenously within 30 min before ending the operation. The dripping was completed within 30 min. PCIA was started as soon as the end of the surgery and the total dose of lappaconitine was 36 mg. Tramadol (100 mg) was intravenously dripped to patients in the tramadol group 30 min before ending the operation. PICA was started as soon as the end of the surgery and the total dose of tramadol was 900 mg. Pethidine (50 mg) and droperidol (2. 5 mg) was intramuscularly injected to patients in the blank control group for pain relief according to their complaints. Pain degrees were assessed by visual analog scale (VAS) 12 h before surgery, 12, 24, 48, and 72 h after surgery. Blood samples were withdrawn at the same time point. Contents of serum C3 and C4 were determined by immunoturbidimetry.
VAS scores of the blank control group were significantly higher after surgery than before surgery (P <0. 01). There was no statistical difference in VAS scores between before surgery and after surgery in the tramadol group and the lappaconitine group (P >0. 05). VAS scores were significantly lower at each post-surgery time point in the tramadol group and the lappaconitine group than in the blank control group with statistical difference (P < 0.01). There was no statistical difference in VAS scores at each post-surgery time point between the tramadol group and the lappaconitine group (P >0. 05). Compared with before surgery, contents of serum C3 and C4 significantly decreased in all of the three groups at 12, 24, and 48 h after surgery (P < 0.05, P < 0.01). They recovered to the pre-surgery level till 72 h after surgery (P > 0.05). Serum C3 and C4 contents at 48 h after surgery were higher in the tramadol group than in the blank control group (P < 0.05). Serum C3 and C4 contents at 24 and 48 h after surgery were higher in the lappaconitine group than in the blank control group (P < 0.05). There was no statistical difference in serum C3 and C4 contents at each time point between the tramadol group and the lappaconitine group (P > 0.05). VAS scores were obviously negatively correlated with serum contents of C3 and C4 (r = -0.622, r = -0.649, P < 0.01).
Lappaconitine (used at the dose in this study) showed better pain relief effect after surgery. Besides, it could inhibit the surgic wound and pain, and elevate serum contents of C3 and C4.
探讨高乌甲素对直肠癌手术患者自控静脉镇痛（PCIA）及血清补体3和4（C3和C4）水平的影响。
选取60例拟行直肠癌手术的患者，分为3组，即空白对照组、曲马多组和高乌甲素组，每组20例。高乌甲素组在手术结束前30 min静脉滴注高乌甲素（8 mg），手术结束后即刻开始PCIA，高乌甲素总剂量为36 mg。曲马多组在手术结束前30 min静脉滴注曲马多（100 mg），30 min内滴完，手术结束后即刻开始PCIA，曲马多总剂量为900 mg。空白对照组根据患者疼痛情况肌内注射哌替啶（50 mg）和氟哌利多（2.5 mg）镇痛。于术前12 h、术后12、24、48和72 h采用视觉模拟评分法（VAS）评估疼痛程度，并于同一时间点采集血样，采用免疫比浊法测定血清C3和C4含量。
空白对照组术后VAS评分显著高于术前（P<0.01）。曲马多组和高乌甲素组术前与术后VAS评分比较差异无统计学意义（P>0.05）。曲马多组和高乌甲素组术后各时间点VAS评分均显著低于空白对照组，差异有统计学意义（P<0.01）。曲马多组与高乌甲素组术后各时间点VAS评分比较差异无统计学意义（P>0.05）。与术前比较，三组术后12、24和48 h血清C3和C4含量均显著降低（P<0.05，P<0.01），术后72 h恢复至术前水平（P>0.05）。术后48 h曲马多组血清C3和C4含量高于空白对照组（P<0.05）。术后24和48 h高乌甲素组血清C3和C4含量高于空白对照组（P<0.05）。曲马多组与高乌甲素组各时间点血清C3和C4含量比较差异无统计学意义（P>0.05）。VAS评分与血清C3和C4含量呈明显负相关（r=-0.622，r=-0.649，P<0.01）。
本研究剂量的高乌甲素术后镇痛效果较好，还可抑制手术创伤和疼痛，并提高血清C3和C4含量。
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