不同镇痛方法对子宫切除术后患者血糖、胰岛素和皮质醇水平的影响

Effects of different analgesic techniques on blood glucose, insulin and cortisol in post-hysterectomy patients

目的 评价4 种常见的不同镇痛方法对子宫切除术后应激反应的抑制程度,以选择较为合理的镇痛方法。方法 根据镇痛方法的不同,将48例行子宫切除术患者随机分为4组:罗哌卡因复合芬太尼硬膜外镇痛组(Ⅰ组);芬太尼静脉镇痛组(Ⅱ组);罗哌卡因复合曲马多硬膜外镇痛组(Ⅲ组);曲马多静脉镇痛组(Ⅵ组)。观察麻醉前、手术后2、24、48、72 h血糖、胰岛素和皮质醇水平的变化。结果 ①4种镇痛方法均能提供良好的镇痛效果;②在抑制术后高血糖和术后应激方面Ⅰ组和Ⅲ组好于Ⅱ组和Ⅵ组,尤以Ⅲ组为优。结论 硬膜外镇痛可以更有效的降低术后高血糖反应,抑制术后应激反应,以罗哌卡因复合曲马多组为更优。

Objective To compare the effects of four different analgesic techniques on hyperglycemia and stress response to abdominal hysterectomy so as to select a more reasonable analgesic model. Methods Forty-eight patients were randomly divided into four groups: groupⅠreceived 0.2% ropivacaine+fentanyl 2 μg/mL+ 0.008% ondansetron for PCEA; groupⅡreceived fentanyl 8 μg/mL+ 0.008% ondansetron for PCIA; groupⅢ received 0.2% ropivacaince+tramadol 2 mg/mL+0.008% ondansetron for PCEA and groupⅥ received tramadol 8 mg/mL+ 0.008% ondansetron for PCIA. The four groups all included loading dose of 5 mL, bolus of 1mL with lock time of 10 minutes and background 1 mL/h. The level of blood glucose, insulin and cortisol were observed at five points: before anesthesia, at 2nd hour, 24th hour, 48th hour and 72th hour after the end of surgery. Results All the four analgesic techniques produced satisfactory pain relieve. Hyperglycemia was inhibited more efficiently in groupⅠand group Ⅲ than in groupⅡ and groupⅥ(P<0.05). The epidural analgesic could reduce the effects of stress response to abdominal hysterectomy. GroupⅢ is superior to the others. Conclusion Epidural analgesic can reduce hyperglycemia and stress response to abdominal hysterectomy more efficiently. Combined ropivacaine with tramadol for PCEA is a better analgesic model.