腹腔内自控镇痛对术后疼痛和皮质醇的影响

Effect of intraperitoneal patient-controlled analgesia on post-operative pain and cortisol level

目的探讨腹腔内自控镇痛的临床效果和可行性并与硬膜外自控镇痛比较。方法选择结肠癌根治术患者45例,随机分为3组,A组为硬膜外自控镇痛组,B、C组为腹腔内自控镇痛组,药物配方为舒芬太尼100μg、0.75%罗哌卡因20 ml、用0.9%生理盐水稀释至100 ml。C组在此方基础上加氯胺酮100 mg。腹腔内管置放于术侧。观察术后镇痛效果用VAS评分,并观察皮质醇变化。结果VAS评分3组无统计学意义,术后4 h 3组皮质醇均高于术前值,且A组与B、C组比较有统计学意义（P〈0.05）。恶心、呕吐、皮肤瘙痒、排气时间等副作用B、C两组均好于A组。结论腹腔内自控镇痛临床效果显著,可安全用于术后自控镇痛,其镇痛效果与硬膜外自控镇痛相当。

Objective To investigate the clinical effect and feasibility of intraperitoneal patient -controlled analgesia（PCA） ,and compare with epidural PCA. Methods Forty-five patients undergoing radical resection of colon cancer were randomly divided into three groups. Group A was epidural patient-controlled analgesia. Both group B and group C were intraperitoneal patient-controlled analgesia. The drug formula in group B included sufentanil 100 μg, 0.75% ropivacaine 20 ml, diluted with NS to 100 ml,while ketamine 100 mg was added in the above mixture for group C. Intraperitoheal tube were placed at the operation side. Post-operative analgesia effect was evaluated using VAS and cortisol changes as well. Results VAS between the three groups demonstrated no statistical difference. Cortisol levels in all three gropus increased 4 hours after operation and the result in group A was statistical difference in comparison with group B and group C. Side effects such as nausea, vomiting and skin itching as well as bowel discharging time exhibited better results in group B and group C than that in group A. Conclusion The effects of intraperitoneal patient-controlled analgesia after operation are remarkable and comparable with epidural PCA.