不同镇痛方式对腹腔镜胆囊切除术患者血浆皮质醇和血糖的影响

Effect of different analgesia on plasma cortisol and glucose in the patients undergoing Laparoscopic Cholecystectomy

目的研究不同镇痛方式对腹腔镜胆囊切除术患者术后疼痛的影响。方法选择ASAⅠ或Ⅱ级行择期腹腔镜胆囊切除术老年患者60例,随机分为地佐辛组(D组,n=20)、氟比洛芬酯Ⅰ组(F组,n=20)和罗哌卡因组(R组,n=20)。D组于手术结束前5分钟静脉推注地佐辛0.1 mg/kg进行后处理;F于手术结束前5分钟静脉推注氟比洛芬酯1.0 mg/kg进行后处理;R组于手术结束前向切口内喷洒0.75%盐酸罗哌卡因4 mL,并在颈部切口两侧注入0.75%盐酸罗哌卡因6 mL封闭治疗。观察3组患者在麻醉前5分钟(T0)、术后6h(T1)、术后24 h(T2)、术后48h(T3)、术后72 h(T4)等各时点血浆皮质醇(Cor),血糖(Glu)的水平。记录T2、T3、T4时使用镇痛药的患者比例和VAS(视觉模拟评分)。结果与T0比较:T1、T2时,D组、R组血浆Cor和GLU升高(P<0.05)。与F组比较:T1、T2时,D组、R组血浆Cor和GLU降低(P<0.05);T2时R组需要使用镇痛药的患者比例显著下降(P<0.01);T4时D组、R组需要使用镇痛药的患者比例均下降(P<0.05);T2、T3、T4时VAS无差异。结论腹腔镜胆囊切除术患者使用罗哌卡因封闭治疗,能取得较好的镇痛效果,并能有效地抑制围术期应激反应。

Objective To investigate the effect of different analgesia in the postoperative pain of laparoscopic cholecystectomy.Methods Sixty ASA I or II patients requiring elective laparoscopic cholecystectomy were enrolled and randomly divided into dezocine group（Group D n=20）,flurbiprofen axebil group（Group F,n=20） and ropivacaine group（Group R,n=20）.Group D were pretreated with dezocine 0.1 mg/kg 5 minutes before the end of operation.,Group F were pretreated with flurbiprofen axebil 1.0 mg/kg 5 minutes before the end of operation.Group R were injected with 0.75% ropivacaine hydrochloride 6 mL into the scheduled incision site,and sprayed with 0.75% ropivacaine hydrochloride 4 mL to incision site before the end of operation;The plasma cortisol and glucose levels of 3 groups were measured at 5 min before anaesthesia（T0）,and at 6 h（T1）,24 h（T2）,48 h（T3） and 72 h（T4） after the operation.The percentage of patients who required analgetics and VAS scores at T2、T3、T4 were recorded.Results The plasma Cor and plasma glucose levels at T1,T2 were higher compared to that at T0 in group D and R（P0.05）.Compared with those in group F,The plasma Cor and plasma glucose levels at T1,T2 were lower in group D andR（P0.05）;There were significant lower in the percentage of patients requiring analgetics in group R at T2（P0.01）,and there were lower in group D、R at T4（P0.05）.There were no difference between three groups in VAS scores at T2、T3、T4.Conclusion Using ropivacaine blockade treatment in patients undergoing laparoscopic cholecysterctomy can result in better analgetic effects,and effectively inhibit the stress reaction in perioperative periods.