舒芬太尼复合罗哌卡因超前镇痛对胃癌患者应激反应的影响

The Effects of Stress Reaction on Patients with Cancer of Stomach in Preemptive Analgesia by Sufentanil Combined Ropivacaine

目的探讨舒芬太尼复合罗哌卡因超前镇痛对胃癌患者应激反应的影响。方法 44例行改良根治术胃癌患者,随机分为舒芬太尼复合罗哌卡因超前镇痛组(简称舒芬太尼组)和对照组,舒芬太尼组采用PCEA超前镇痛,对照组采用PCEA常规镇痛方式,分别在穿刺前、手术完毕后2 h以及术后第2 d清晨3个时点放射免疫法测定皮质醇(COR)、促肾上腺皮质激素(ACTH)血浆浓度,免疫比浊法测定C反应蛋白(CRP)浓度,比较两组术后2、6、12、24 h时点休息时和咳嗽时视觉模拟评分(VAS)。结果两组患者术后各时点COR、ACTH、CRP含量均明显或显著高于术前(P<0.05,P<0.01)。组间比较,舒芬太尼组COR、ACTH、CRP含量均明显低于对照组(P<0.05);术后2h时点休息和咳嗽时舒芬太尼组患者VAS疼痛评分明显低于对照组(P<0.05),咳嗽时6h和12h时点两组差异明显(P<0.05)。结论舒芬太尼复合罗哌卡因行超前镇痛用于胃癌患者能有效缓解术后应激反应,具有较强的镇痛效果和安全性。

Objective To investigate the effects of stress reaction on patients with cancer of stomach in preemptive analgesia by sufentanil combined ropivacaine.Methods 44 patients with cancer of stomach undergoing radical correction were randomly divided into sufentanil combined ropivacaine group（sufentanil group）and control group,preemptive analgesia wered used in sufentanil group,routine analgesia mode was used in control group.Cortisol and ACTH,C-reactive protein before paracentesis,after 2hours of operation,and the second day after operation and visual simulation score at rest and coughing at 2hours,6 hours,12 hours,24 hours after operation were compared.Results Content of COR、ACTH、CRP after operation were significantly higher than that of preoperative（P0.05,P0.01）.group comparison,COR、ACTH、CRP of sufentanil group were significantly lower than that of control group（P0.05）;there was significant differene in VAS scores at rest and coughing（P0.05）.Conclusions preemptive analgesia sufentanil combined ropivacaine effectively reduce postoperative stress reaction.