上腹部手术后镇痛对儿茶酚胺的影响

The effects of postoperative analgesia on plasma catecholamine after upper abdominal surgery

选择３０例上腹部手术患者，随机分为三组，每组１０例，采用Ｎ２一Ｏ２一安氟醚（ＧＯＥ）吸入麻醉，其中镇痛两组术终采用０．２５％丁哌卡因２０ｍｌ行腹腔神经丛阻滞，术后硬膜外分别持续滴入０．１２５％丁哌卡因及０．０００２５％芬太尼生理盐水溶液，在术终及术后２、５、８小时分别采静脉血分离血浆，并同时用线性视觉模拟评分法作疼痛程度评定，标本采用反相离子对色谱一电化学检测法分析血中儿茶酚胺浓度。结果镇痛两组疼痛评分较低，与对照组相比差异显著（Ｐ＜０．０１）。多巴胺血浆浓度在组间及组内比较均无差异（Ｐ＞０．０５），而肾上腺素和去甲肾上腺素的血浆浓度术后２、５、８小时与术终相比差异非常显著（Ｐ＜０．０１），三组间比较术终无差异，而术后２、５、８小时镇痛两组与对照组比较差异显著（Ｐ＜０．０１），但镇痛两组间相比无差异（Ｐ＞０．０５）。结论：上腹部手术后在腹腔神经丛阻滞下，行硬膜外术后镇痛既能明显减轻患者的痛苦，又能有效地阻止术后疼痛应激引起儿茶酚胺的明显变化。//

Thirty patients undergoing upper abdominal operations under N2O-O2-enflurane anesthesia were randomly di vided into 3 groups. twenty patients were treated by coeliac block before closure of the surgical wound and postoperatine epidural analgesia were provided by continuous drip with 0. 125 % bupivacaine (B group, n = 10 ) or 0. 00025 % fentanyl (F group, n = 10) respectively. The remaining 10 patients were observed without analgesia as control. The level of pain was assessed by visllal analogue scale (VAS) and plasma catecholamine concentrations were measured at 2, 5 and 8 hours postoperatively. The results revealed that VAS were markedly lower in B and F groups than the one of control, P<O. 01. The plasma dopamine concentrations were similar among three groups,P >0' 05,but the levels of adrenaline and noradrenaline were significantly lower at 2, 5 and 8 hours postoperatively in B and F groups than the ones of the control respectively. It is concluded that coeliac block combined with postoperative epidural analgesia may attenuate the stress responses to the pain after upper abdominal operations.