肝脏术后舒芬太尼病人自控镇痛对胃肠动力的影响

Effects of patient-controlled analgesia with sufentanil on gastro-intestinal motility after hepatic surgery

目的评价舒芬太尼自控镇痛对肝脏手术病人术后胃肠动力的影响。方法择期肝脏手术病人30例,ASAⅠ级或Ⅱ级,年龄18～64岁,随机分为3组,每组10例,B组应用0．25％布比卡因术后病人自控硬膜外镇痛,BS组应用0．125％布比卡因混合0．4μg/ml舒芬太尼术后病人自控硬膜外镇痛,S组应用0．8μg/ml舒芬太尼术后病人自控静脉镇痛。B组和BS组背景剂量4 ml/h、PCEA剂量4 ml/次,锁定时间10 min;S组背景剂量2．5 ml/h、PCIA剂量5 ml/次,锁定时间8 min。记录3组术后48 h胃肠消化间期移行性复合运动（MMC）、病人术后排气时间、胃肠引流量、术后24、48 h VAS评分及住院时间,观察循环、呼吸变化及不良反应。结果术后30 min内所有病人MMC均消失,术后30 min后出现的MMC仅由Ⅰ相和Ⅲ相构成,缺乏MMCⅡ相。B组MMCⅢ相的曲线下面积最大,收缩持续时间最长,收缩幅度最高（P＜0．05）。3组病人均镇痛良好,BS组术后48 h VAS评分最低（P＜0．05）。与B组比较,BS组和S组低血压发生率降低（P＜0．05）。结论与布比卡因硬膜外镇痛相比,肝脏术后病人舒芬太尼硬膜外或静脉镇痛时胃肠动力的恢复延迟。

Objective To evaluate the effects of patient-controlled analgesia （PCA） with sufentanil on migrating motor complex （MMC） of gastro-intestinal tract during 48 h after hepatic surgery. Methods Thirty ASAⅠ or Ⅱ patients aged 18-64 yr undergoing hepatic surgery performed under general anesthesia combined with epidural block were randomly divided into 3 groups （ n = 10 each） ： group Ⅰ received postoperative epidural PCA （PCEA） with 0.25% hupivacaine; groupⅡ received PCEA with 0.125% bupivacaine ＋ sufentanil 4μg/ml and group m received postoperative intravenous PCA （PCIA） with 0.8μg/ml sufentanil. In group Ⅰ and Ⅱ the PCEA pump was set up to deliver a 4 ml bolus dose with 10 min lockout interval and background infusion of 4 ml/h . In group m the PCIA pump was programmed to allow a 5 ml bolus dose with 8 rain lockout interval and background infusion of 2.5 ml/h . A gastric tube and a gaslro-intestinal manometric tube were inserted before operation and placed in the gastric antrum and duodenum with the help from the surgeon during operation. MMC was measured and analyzed using Synectics Micro Digitrapper and Polygram software. Intensity of pain was measured by VAS and recorded at 24 and 48 h after operation. BP, RR and side-effects, the time when the patients passed the flatus, the duration of hospital stay and gastric retention were recorded. Results There was no MMC in the 30 min after operation. Then MMC reappeared with only phase Ⅰ and Ⅲ . The phase Ⅱ was lacking, indicating that gastrointestinal motility had not yet completely recovered. The area under the curve of MMC-phase m was the largest; the duration was longest and the degree of contraction was highest in group Ⅰ.All the indexes of MMC-phase Ⅲ in group Ⅰ were significantly different from those in the other two groups. All three groups provided good analgesia.VAS score was the lowest at 48 h after operation in group Ⅱ. The patients in group Ⅰ were prone to hypotension. Conclusion PCA with sufentanil delays recovery of gastro-intestinal motility after operation as compared to PCA with bupivacaine alone.