术后镇痛对肠蠕动影响的临床研究

Effect of Patient Controlled Analgesia on Intestiral Peristalsis

为比较不同的术后镇痛药物配方和不同手术种类对病人术后肠蠕动恢复情况的影响 ,选择 2 70例ASAⅠ Ⅱ级病人 ,其中 ,妇产科、骨科及普通外科各 90例 ,各科手术病人根据不同的镇痛方案随机分成 3组 :组Ⅰ ,0 .12 5 %布比卡因 + 0 .0 0 5 %吗啡 + 0 .0 0 5 %氟哌利多 ;组Ⅱ ,0 .12 5 %布比卡因 + 0 .0 0 0 5 %芬太尼 + 0 .0 0 5 %氟哌利多 ;组Ⅲ ,对照组。上述各组按比例配制 ,总容量为 10 0ml。自控镇痛 (PCA)指标设置 :负荷量 5 .0ml,背景剂量 2 .0ml/h ,PCA剂量 2 .0ml,锁定时间 10min ,持续镇痛 3 6h。于镇痛治疗 4、8、12、2 4、3 6h进行观察 ,同时记录各时点疼痛程度(VAS评分法 )、镇静状态 (Ramsay评分法 )、肱动脉平均动脉压 (MAP)、心率 (HR)、呼吸频率 (RR)、脉搏氧饱和度(SpO2 )测定值 ,并记录肠蠕动恢复时间。结果显示 :组Ⅰ与组Ⅱ均取得较好的镇痛效果 ,VAS评分显著低于组Ⅲ (P<0 .0 1) ,但组Ⅰ与组Ⅱ无明显差异 (P >0 .0 5 ) ;各科病人肠蠕动恢复时间为普通外科 >妇产科 >骨科 (P <0 .0 5 ) ;组Ⅰ与组Ⅲ相比 ,肠蠕动恢复时间无明显差异 ( P >0 .0 5 ) ,但组Ⅱ较组Ⅰ、Ⅲ肠蠕动恢复时间明显缩短 ( P<0 .0 5 ) ;镇痛期间各组MAP、HR、RR与麻醉前比较均无明显差异 ,SpO2 都保持在 95 %以上。?

To ascertain the role of patient controlled epidural analgesia(PCEA) and operation kinds on recovery of intestinal peristalsis after surgery,270 patients ASA Ⅰ Ⅱ grade, including 90 patients of abdominal surgery,90 patients of gynecology and 90 patients of orthopedics. Every section was randomly divided into three groups according to the content of drugs.Group Ⅰ:0.125% Bupivacaine+0.005% Murphine+0.005% Droperidol.Group Ⅱ:0.125% Bupivacaine+0.0005% Fentanyl+0.005% Droperidol.Group Ⅲ:Control group. The total volume of every group was added to 100ml with 0.9% sodium chloride. The loading dose at 5ml, continuous infusion dose at 2 ml/h,PCA bolus dose at 2 ml,and lockout time at 10min were set. All patients were taken PCEA for 36 hours. The pain score of visual analog scale(VAS), sedative scores of Ramsay scale, respiratory, hemodynaic paremeters and side effects were recorded at various times (4,8,12,24,36 h)postoperatively. The time of the recovery of intestinal peristalsis was also recorded. Results:good analgesic effect could be found in groupⅠand Ⅱ,the VAS grade were significantly lower in groupⅠandⅡthan that of group Ⅲ(P< 0.01 )),but there were no significant difference between themselves(P> 0.05 ).The time of the recovery of intestinal peristalsis:abdominal surgery>gynecology>orthopedics(P< 0.05 ).There were no significant difference between groupⅠandⅢ(P> 0.05 ) but the time of the recovery of intestinal peristalsis was shorter in group Ⅱ than that of group Ⅰand Ⅲ(P< 0.05 ).MAP(Mean Artery Pressure),HR(Heart Rate) and RR(Respiratory Rate) had no significant changes in all groups, SpO 2were maintained over 95% in all groups. Conclutions:Compound solution with low concentration of bupivacaine and morphine/fentanyl could be used for postoperatively analgesia with good analgesic effect without significant influence on cardio respiratory function.It seems that the recovery of intestinal peristalsis is closely related to the kind of operation. With the combination of bupivacaine, morphine has no effect on intestinal peristalsis,while fentanyl shorten ileus.