不同镇痛模式对原发性高血压患者肛肠术后疼痛及应激反应的影响

Effects of different analgesia modal on postoperative pain and stress response in patients with essential hypertension after anorectal surgery

目的观察3种镇痛模式对原发性高血压患者肛肠术后镇痛及应激反应的效果，寻求更为合理的镇痛方法。方法择期行肛肠科手术的高血压患者60例，随机分为3组：左旋布比卡因局部浸润与可乐定口服组（Ⅰ组）；静脉应用芬太尼与可乐定自控镇痛PCIA组（Ⅱ组）；硬膜外应用左旋布比卡因与可乐定自控PCEA组（Ⅲ组）。记录VAS评分，同时监测血浆肾上腺素、去甲肾上腺素与血糖。结果三组VAS术后10h内无统计学差异（P〉0．05），其后Ⅰ组评分明显高于Ⅱ组和Ⅲ组（P〈0．05），Ⅱ组评分明显高于Ⅲ组（P〈0．05）。与术前比较，Ⅰ组术后SBP和HR明显升高（P〈0．05），Ⅱ组、Ⅲ组术后SBP和DBP均下降（P〈0．05）。Ⅰ组血中肾上腺素和去甲肾上腺素明显上升（P〈0．05），Ⅱ组和Ⅲ组均显著下降（P〈0．05）；与术前比较，Ⅰ组血糖上升（P〈0．05），Ⅱ组、Ⅲ组无明显变化（P〉0．05）。结论可乐定与芬太尼PCIA和可乐定与左旋布比卡因PCEA用于原发性高血压患者的肛肠术后镇痛效果均佳，尤其PCEA镇痛效果更明显，两者抑制应激反应效果显著。

Objective To observe the analgesic effects and stress response of three modals on essential hypertension （EH） patients after anorectal operation. Methods Sixty patients with EH undergoing anorectal surgery were randomly divided into three groups： group Ⅰ local infiltration of levobupivacaine and oral clonidine; group Ⅱ intravenous fentanyl and clonidine patient-controlled analgesia PCIA; group Ⅲ epidural levobupivacaine and clonidine patient-controlled PCEA. Plasma epinephrine （E）, norepinephrine （NE）, and blood glucose were determined postoperatively. Results VAS after 10 hours had no significant difference （P〉0.05） in the three groups. After that VAS was significantly higher in group I than that in group Ⅱ and m 〈P〈0.05）, and in group Ⅱ was significantly higher than that in group Ⅲ （P〈0.05） compared with the preoperative level, SBP and HR in group Ⅰ significantly increased （P 〈0. 05）, SBP and DBP decreased （P〈0.05） in group Ⅱ and m, which declined more significantly in group Ⅱ （P〈0. 01）. Blood epinephrine and norepinephrine increased significantly （P〈0.05） in group Ⅰ, and significantly decreased in group Ⅱ and Ⅲ （P〈0.05）. Blood glucose increased in Group Ⅰ（P〈0.05） ,no significant change in group Ⅱ and Ⅲ （P〉0. 05）. Conclusion The analgesic effects of clonidine and fentanyl PCIA and levobupivacaine and clonidine PCEA after anorectal surgery in patients with essential hypertension are excellent, particularly PCEA. Inhibitory effects of stress response in both groups are also increased significantly.