高位自控硬膜外镇痛对乳腺癌根治术患者呼吸和内分泌功能的影响

Effects of patient-controlled epidural analgesia on endocrine and respiratory function in patients after radical excision of breast cancer

目的:探讨高位自控硬膜外镇痛 patient-controlled epiduralanalgesia, (PCEA )对乳腺癌根治术患者呼吸及内分泌功能的影响。方法:将 2000-11/2002-08广州市第六人民医院收治的 120例乳腺癌根治术患者根据术后镇痛用药随机分为曲马多组、丁丙诺啡组和对照组,分别于麻醉前、术后 ,, , 和 261224 48h 抽静脉血测定血浆皮质醇、血管紧张素 II、肾上腺素和去甲肾上腺素以及血糖和胰岛素的浓度,同时用视觉疼痛模拟评分量表 (V )测定患者镇痛效果,并监测血压、心率、 AS血氧饱和度、呼吸频率、潮气量、呼气末 CO的变化及不良反应。 2结果:采用镇痛的两组患者 VAS 评分较低,与麻醉前相比差异有非常显著性意义,其中麻醉前和术后 ,, , , 26122448h 时VAS 评分曲马多组分别为 7.9±1.9) 2.5±1.6) 2.2±0.9) 1.7±0.7) 1.5±0.8) ( ,( ,( ,( ,( ,(1.1±0.7)分,丁丙诺啡组分别为(7.0±2.7),(2.5±0.9),(2.5±1.3),(1.1±0.3) 1.2±0.4) 1.2±0.3)分,与对照组 ,( ,( 犤分别为 ( 7.4±2.1) ,(7.8±1.1) 8.3±2.0) 6.9±1.1),( ,(

AIM:To investigate the effects of patient-controlled epidural analgesia(PCEA) on endocrine and respiratory function in patients after radical excision of breast cancer. METHODS:Totally 120 patients undergoing radical excision of breast cancer were selected from Guangzhou Sixth People's Hospital during November 2000 and August 2002.They were randomly divided into three groups:tramadol group,buprenorphine group and control group.Blood samples were taken from peripheral vein before analgesia,2,6,12,24 and 48 hours after operation for the determination of plasma glucose(BS),insulin,cortisol,angiotensin Ⅱ(A Ⅱ),epinephrine and norepinephrine concentration.Postoperative analgesia was assessed by visual analogue scale(VAS) score.Blood pressure(BP),heart reate(HR),SpO2,respiratory rate(RR),tidal volume(VT),and PETCO2 were monitored and side effects were recorded. RESULTS:The VAS score was significantly lower in two analgesia groups than that in control group,and also significantly lower than that before anesthesia.The VAS score before anesthesia,2,6,12,24,48 hours after operation was (7.9±1.9),(2.5±1.6),(2.2±0.9),(1.7±0.7),(1.5±0.8),(1.1±0.7) points respectively in tramadol group,and (7.0±2.7),(2.5±0.9),(2.5±1.3),(1.1±0.3),(1.2±0.4),(1.2±0.3) points in buprenorphine group,either of which was significantly different from that of the control group[(7.4±2.1),(7.8±1.1),(8.3±2.0),(6.9±1.1),(4.7±0.9),(3.4±1.1) points respectively],but no significant difference was found between the former two groups at each time point.There was no significantly difference in SpO2,RR,VT,and PETCO2 between two analgesia groups(P >0.05) during the postoperative period.The respiratory function was insignificantly different among the three groups.The levels of endocrine hormones were insignificantly different between the two analgesia groups,but those in either group were significantly different from those of the control group,and also significantly different in the inter-group comparison,as compared with those before anesthesia. CONCLUSION:The analgesic effect of PCEA is perfect and does not cause the serious respiratory inhibition,so well-operated PCEA has little impact on respiratory function,and adverse action is found unobvious.Having inhibited entrance of pain stimulus,PCEA can also partly inhibit stress responses in patients after operation,accordingly,to some extent helping to stabilize the levels of hormones and metabolism in the perioperative patients after radical excision of breast cancer.