静脉内曲马多病人自控镇痛对乳腺癌根治术患者术后内分泌功能的影响

Effect of Patient-Controlled Intravenous Tramadol Analgesia on Endocrine Function of Patients after Radical Excision of Breast Cancer

目的：探究静脉内病人自控镇痛(PCIA)对乳腺癌根治术患者术后疼痛所致应激反应的调制作用。方法：30例拟在全麻下行选 择性乳腺癌根治术患者随机分为静脉内曲马多病人自控镇痛组(T 组)和对照组(C 组)。采用 LCP 镇痛模式，即负荷量+持续量+冲 击量。分别于围术期不同时点采集静脉血测定血浆胰岛素、促肾上腺皮质激素、皮质醇、肾上腺素和去甲肾上腺素的浓度；采用视觉 疼痛模拟评分(VAS)和 Ramsay 镇静评分法评估患者术后镇痛效果和镇静程度，同时监测血压、心率、血氧饱和度、呼吸频率及不良反 应情况。结果：术后48h 内，T 组病人 VAS 评分较低，Ramsay 评分则较高，所测各项内分泌应激激素水平也显著低于对照组。两组 间呼吸功能参数及不良反应发生率比较无明显差异。结论：术后静脉内曲马多病人自控镇痛具有良好的镇痛和镇静效果，副作用较 少，且对呼吸功能无明显影响。术后良好的 PCIA 可通过减轻疼痛刺激而部分抑制机体的应激反应，从而对乳癌根治术患者术后应 激激素水平及代谢水平的稳定有一定的帮助。

Objective： To investigate the modulation of patient-controlled intravenous analgesia（PCIA） on postoperative pain stress response. Methods： Thirty patients Scheduled for select radical excision of breast cancer under general anesthesia were randomly divided into patient-controlled intravenous tramadol analgesia group（group T）and control group（group C）. PCIA was administrated with LCP pattern, loading dose plus continuous infusion plus bolus. Blood samples were collected from peripheral vein at perioperative different time points for the determination of plasma insulin,adrenocorticotropic hormone,cortisol,epinephrine and norepinephrine concentration, postoperative analgesia and sedation were assessed by visual analogue scale（VAS ）and Ramsay sedation scale;blood pressure,heart rate,oxygen saturation, respiratory rate and side effects were monitored concomitantly. Results： During 48h after operation,VAS of the patients in group T was lower but Ramsay sedation score was greater,and the levels of endocrine stress hormones determined were also obvious lower than that in group C. There were not significant differences on the parameters of respiratory function and the incidence of side effects between two groups. Conclusion：Postoperative patient-controlled intravenous tramadol analgesia has a better analgesic and sedative effect and few side effects, and has not markedly impact on respiratory function. Having attenuated pain stimulus,a good postoperative PCIA can partly inhibit stress responses of the patients after operation,to some extent accordingly helping to stabilize the levels of stress hormones and metabolism of the patients after radical excision of breast cancer.