恩再适预镇痛对术后自控静脉镇痛应激反应的影响

Stress reaction of postoperative injection of analgecine on patient-controlled intravenous analgesia of fentanyl

目的比较术前预用恩再适对芬太尼用于子宫全切术后患者自控静脉镇痛的临床效应和术后应激反应的影响。方法选择全身麻醉下子宫全切术的患者120例，术后采用芬太尼行患者自控静脉镇痛（PCIA），并根据不同的用药方法随机分为3组：A组．芬太尼1mg＋0．9％NaCl共100ml；B组．芬太尼0．5mg＋0．9％NaCl共100ml；C组．术前晚、麻醉前、术毕各经静脉注射恩再适7．2u，芬太尼0．5mg＋0．9％NaCl共100ml，每组40例。术后48h内采用视觉模拟评分（VAS）、PCA按压次数、镇痛满意度评分来观察各组镇痛效应；测定术前1h、术后4h、16h、48h皮质醇和β-内啡肽的含量。结果B组术后2h时的VAS评分显著高于A和C组（P〈0．05），而2h后的VAS3组间差异无统计学意义（P〉0．05）。患者术后镇痛满意度评分B组显著低于A和c组（P〈0．05）。术后4h各组患者皮质醇和β-内啡肽的含量均显著高于术前1h（P〈0．05）；术后16hA组与B组患者皮质醇和β-内啡肽的含量显著高于C组（P〈0．05）；而术前1h和术后48h各组之间的皮质醇和β-内啡肽含量的比较差异无统计学意义（P〉0．05）毛结论术前预用恩再适复合小剂量芬太尼用于子宫全切术后静脉镇痛取得满意的镇痛效果，并能减少芬太尼的用量和抑制患者术后静脉镇痛的应激反应。

Objective To compare the effect and stress reaction of preoperative intravenous injection of analgecine and complications of patient-controlled intravenous analgesia （PCA）of different doses of fentanyl in postoperative total hysterectomy patients. Methods 120 patients underwent total hysterectomy in general anesthesia were randomly divided into three groups with forty cases each. 7.2 U mg in group A ,0. 5 mg in group B, fentanyl O. 5 mg in group C. Besides,patients in group C were injected with Analgecine at night before the operation, preoperation and postoperation respectively. The visual analog scale （VAS） , times of PCA, patient ＇ s satisfaction were recorded during the period of postoperative 48 hours. Results The VAS of group B at 2 hours after operation was significantly higher than that of group A and C（P 〈0. 05） ,which became similar 2 hours later（P 〉 0.05 ）. The patient＇ s satisfaction in group B was significantly lower than that in group A and C （ P 〈 0. 05）. At 4 hours after operation ,the concentrations of cortisol and β-endorphin in three groups were significantly higher than those of cortisol and β-endorphin at 1 hours before operation（P 〈0. 05） ;the concentrations at 16 hours after operation in group A and group B were also significantly higher than those in group C （ P 〈 0. 05 ）. At 48 hours after operation,there showed no statistical differences in the concentrations among the three groups, and the concentrations did not significantly differ from those before operation. Conclusion Preoperative intravenous injection of analgecine has a better effect on patient-controlled intravenous analgesia（PCIA） of fentanyl and can reduce fentanyl requirement and stress reaction in total hysterectomy patients.