术后硬膜外自控镇痛对全身炎症反应综合征的干预作用

Effects of postoperative patient-controlled epidural analgesia on systemic inflammatory response syndrome

目的研究术后患者硬膜外自控镇痛（PCEA）对全身炎症反应综合征（SIRS）的干预作用。方法严格选择上腹部手术患者60例,随机分为两组（n=30）,即罗哌卡因和芬太尼硬膜外自控镇痛组（E组）和对照组（C组）。麻醉方法均选择全麻气管插管加硬膜外麻醉,手术结束时行PCEA,镇痛模式采用负荷剂量＋维持剂量＋自控镇痛（LCP）：负荷剂量3-5 ml＋维持剂量2-2.5 ml/h,PCA剂量1 ml/次,锁定时间15 min。术后分别记录T0h、T6 h、T24 h和T48 h时间点的心率（HR）、呼吸频率（R）、体温（T）、血白细胞总数（WBC）、C反应蛋白（CRP）;对两组各相应时间点进行视觉模拟镇痛评分（VAS）评价疼痛程度。结果与T0 h组内各时间点比较：C组R在T6 h、T24 h,而T、WBC、CRP在T6 h、T24 h和T48 h差异均有统计学意义（P〈0.05）;E组R在T48 h,WBC在T6 h,CRP在T24 h、T48 h差异均有统计学意义（P〈0.05）。与C组组间比较：HR、R在T24 h,T在T6 h、T24 h,WBC、CRP在T6 h、T24 h、T48 h差异均有统计学意义（P〈0.05）。两组组内VAS评分各时间点与T0 h比较差异均有统计学意义（P〈0.01）,组间VAS评分在各时间点比较差异均有统计学意义（P〈0.01）。结论术后有效的PCEA可以抑制SIRS的产生,有利于患者康复。

Objective To investigate the effects of postoperative patient-controlled epidural analgesia（PCEA） on the systemic inflammatory response syndrome（SIRS）.Methods Sixty patients with upper abdominal surgery were strictly selected and randomly divided into two groups（n=30）： PCEA with ropivacaine and fentanyl（E group） and control group（C group）.The ways of anesthesia were chosen in general anesthesia plus epidural anesthesia.PCA was used under LCP mode by loading dose of 3 ～ 5 ml＋background dose of 2～2.5 ml/h,PCA dose of 1 ml/time at the end of surgery,and the lockout time was 15 min.The data of heart rate（HR）,respiratory rate（R）,body temperature（T）,total number of white blood cell（WBC） and C-reactive protein（CRP） were observed at the time point of T0 h,T6 h,T24 h and T48 h.The evaluation of pain by visual analogue pain score（VAS） was carried out at corresponding time points in two groups.Results Compared with the T0 h at any time points：In the C group,R and T had statistical difference,R at T6 h and T24 h（P〈0.05）,but T,WBC and CRP at T6 h and T48 h（P〈0.05）;In the E group R at T48 h（P〈0.05）,but WBC at T6 h（P〈0.05）,CRP at T24 h and T48 h（P〈0.05）.Compared with the C group,HR and R were statistical differences at T24 h（P〈0.05）,T at T6 h and T24 h（P〈0.05）,WBC and CRP at T6 h,T24 h and T48 h（P〈0.05）.Compared with the T0 h,VAS score in the two groups were statistical difference at any time points（P〈0.01）.VAS score was statistical difference at any time points（P〈0.01）.Conclusion The effective postoperative PCEA can decreased occurrence of SIRS and improve patient′s rehabilitation.