多模式镇痛用于全子宫切除术后镇痛的疗效观察

Effects of multimodal analgesia on total hysterectomy

目的观察多模式镇痛用于全子宫切除术后镇痛的临床效果。方法 80例ASAⅠ～Ⅱ级择期在硬膜外麻醉下行全子宫切除术患者,采用随机数字表法,将患者随机分为观察组和对照组,每组40例。对照组术前静脉和硬膜外腔分别注射5 mL生理盐水,观察组术前静脉注射氯胺酮20 mg、硬膜外腔注布托啡诺1 mg,均用生理盐水稀释至5 mL。术后患者均给予PCEA镇痛,记录术后12、24 h VAS评分和术后24 h PCEA用量,观察术后第1天8:00时的血糖、皮质醇浓度变化。结果观察组术后12、24 h静息、运动VAS评分和术后24 h PCEA用量分别是(2.36±0.81)、(2.96±0.79)、(2.28±0.74)、(2.88±0.88)和(50.08±1.26),明显低于对照组的(3.24±0.66)、(3.84±0.90)、(2.96±0.84)、(3.52±0.87)和(51.38±1.32),P<0.05。观察组血糖、皮质醇浓度分别是(6.18±0.66)mmol/L和(195.32±50.50)mg/mL,显著低于对照组的(6.86±0.78)mmol/L和(229.12±59.71)mg/mL,P<0.05。结论多模式镇痛显著减轻全子宫切除术后疼痛,降低应激反应。

Objective To observe the effects of multimodal analgesia on total hysterectomy.Methods 80 ASA Ⅰ-Ⅱ patients undergoing elective hysterectomy under epidural anesthesia were randomly divided into observation group and control group（n=40） by using a random number table.The control group was treated with preoperative intravenous and epidural injection saline 5 mL,and the observation group received preoperative intravenous ketamine 20 mg and epidural butorphanol 1 mg.All patients were treated with patient controlled epidural analgesia.The postoperative 12 h,24 h VAS score and dosage of 24 PCEA after operation were recorded.The concentrations of glucose and cortisol were observed in the two groups.Results The postoperative 12 h,24 h resting,movement VAS score and postoperative 24 h PCEA consumption in the observation group were（2.36±0.81）,（2.96±0.79）,（2.28±0.74）,（2.88±0.88） and（50.08±1.26）,which were significantly lower than those[（3.24±0.66）,（3.84±0.90）,（2.96±0.84）,（3.52±0.87） and（51.38±1.32）]in the control group（P0.05）.The concentrations of glucose and cortisol in the observation group were（6.18±0.66） mmol/L and（195.32±50.50） mg/mL,which were significantly lower than those（6.86±0.78） mmol/L and（229.12±59.71）mg/mL in the control group（P0.05）.Conclusion Multimodal analgesia significantly reduced postoperative pain and stress response after hysterectomy.