不同硬膜外镇痛方法对上腹部手术后胃肠动力恢复的影响

The effect of epidural analgesia on gastrointestinal dynamics after epigastric operation

目的研究不同镇痛配方用于上腹部手术术后硬膜外镇痛对胃肠动力学的影响。方法100例择期肝胆外科手术患者,ASAⅠ～Ⅱ级,根据术后镇痛方法不同分为5组,放免法测各组患者术前、术后24h、48h血浆胃动素含量,观察记录各组患者术后6h、12h、18h、24h、48h视觉模拟疼痛评分(VAS),术后恶心、呕吐(PONV)发生率,术后胃肠蠕动恢复时间和肛门第一次排气排便时间。结果吗啡与布托啡诺复合罗哌卡因硬膜外术后镇痛各时点VAS评分无统计学差异(P>0.05),吗啡组术后24h、48h血浆胃动素含量,术后恶心、呕吐(PONV)发生率明显高于布托啡诺组(P<0.05),术后胃肠蠕动时间和肛门第一次排气排便时间明显延长(P<0.05)。结论①吗啡硬膜外术后镇痛不利于胃肠动力的恢复;②阿片受体激动拮抗剂布托啡诺术后硬膜外镇痛,与吗啡及肌注呱替啶比较对胃肠动力影响小,复合罗哌卡因镇痛效果更好。

Objective To study the effect of different anesthesia method and different prescription epidural analgesia on gastrointestinal dynamics after epigastric operation. Methods One hundred patients were randomly divided into different groups： The patients used general anesthesia with epidural anesthesia were divided into four groups： Group A （n=22）,epidural analgesia pump used morphine 5-8rag （50-80μg/ml）＋0.125%ropivaeaine to 100ml; Group B （n=20）, epidural analgesia pump used butorphanol tartrate 5-8mg（50-80μg/ml）＋ 0.9% sodium chloride to 100ml;Group C（n=24） ：epidural analgesia pump used butorphanol tartrate 5-8mg（50-80μg/ml）＋ 0.125% ropivaeaine to 100ml; Group D（n=14）：didn＇t used epidural analgesia pump and just inject pethidine 50mg intramuscularly when feeling pein. The patients used total intravenous anesthesia were group E, epidural analgesia pump was the same to group A. Recorded the quantity of motilin in blood plasm preoperative and postopera- tive 24h,48h. Visual analogue scale （VAS） after operation 6h,12h,l 8h,24h,48h, the incidence rate of postoperative nausea and vomitting（PONV）,passage of flatus and bowel movement. Results （1）Compared the rest groups, VAS of group D was higher（P〈 0.05）, the incidence rate of PONV was lower than group morphine, and higher than group butorphanol tartrate （P〈O.05）.（2） There was no significant differences between group A and E （P〉0.05）. （3） Compared to group C, the quantity of motilin in blood plasm postoperative 24h,48h and the incidence rate of PONV was significantly higher （P〈0.05）, passage of flatus and bowel movement was longer（P〈0.05）.（4） The VAS of group B was higher than group C （P〈0.O5）,and there were no significant difference in other records. Conclusion Epidural analgesia usesd morphine is unadvantageous to recovery of gastrointestinal dynamics. Compared to morphine and pethidine, the effect of butorphanol tartrate is little to gastrointestinal dynamics,and much better with ropivacaine.