不同镇痛方法对胆囊切除术病人糖代谢和康复的影响

Effects of different model of analgesia on the postoperative glucose metabolism and rehabilitation in patients undergoing cholecystectomy

目的 观察比较多途径和单一方式镇痛方法对胆囊切除手术病人糖代谢和术后康复的影响。方法 40例择期在硬膜外阻滞下行胆囊切除术的病人 ,随机分为多途径组 1(M1)、多途径组 2 (M2 )、对照组 1(C1)和对照组 2 (C2 )。C1组于术前从硬膜外腔给予吗啡 1mg +新斯的明 1mg。C2 组术后仅肌注哌替啶镇痛。M1和M2 组在C1基础上于术前至术后 2天口服双氯芬酸 ,M2 组于术毕在切口处采用 0 5 %布比卡因喷洒。结果 M1和M2 组血糖 (Glu)变化平稳。C1组血糖于术后第 1天上升 (P <0 0 5 ) ,C2 组血糖值则从术中至术后第 3天均明显上升 (P <0 0 5或P <0 0 1)。术后第 1天 ,四组胰岛素 (Ins)水平均明显上升 (P <0 0 5或P <0 0 1)。C1和C2 组胰岛素上升幅度明显高于M1和M2 组 (P <0 0 5 )。至术后第 3天 ,M1和M2 组胰岛素水平均恢复至正常水平 (P >0 0 5 ) ,而C1和C2 组胰岛素值仍高于麻醉前值 (P <0 0 5或P <0 0 1)。血浆皮质醇 (Cor)浓度均于术中 6 0分钟时明显上升 (P <0 0 1) ,与M1和M2 组相比 ,升高幅度以C1和C2 组显著 (P <0 0 5 )。IL 6水平在各组未见显著性改变 (P >0 0 5 )。

Objective To compare the effects of multi model with single model analgesia on the postoperative glucose metabolism and rehabilitation in the patients undergoing cholecystectomy.Methods Forty patients undergoing cholecystectomy under epidural blockade were randomly divided into two multimodel analgesia groups (group M 1,group M 2),and two control groups (group C 1,group C 2).Morphine 1mg with neostigmin 1mg as injected into epidural space for postoperative pain relief in group M 1,M 2 and C 1 before incision,but not in group C 2.Pethidine 50mg was injected im as needed for postoperative pain relief in four groups.Dichlofenac sodium 50mg was taken orally twice a day from the operative day to the 2nd postoperative day in group M 1 and M 2,but 0 5% bupivacaine 5ml was spreaded on the area of incision in group M 2 after peritoneum closing.Results There was no significant change in blood glucose levels of group M 1,and M 2 perioperatively.The blood glucose level in group C 1 was significantly increased only on the 1st postoperative day ( P< 0 05),but from the time of 60min after incision to the 3rd postoperative day in group C 2( P< 0 05,or P< 0 01).The plasma insulin level in all four groups was significantly increased on the 1st postoperative day ( P< 0 05,or P< 0 01),which was even more in C 1 and C 2 than that in M 1 and M 2 ( P< 0 05).The plasma insulin level of groups M 1 and M 2 returned to the baseline on the 3rd postoperative day,but it was still higher than the baseline on that time in group C 1 and C 2 ( P< 0 05,or P< 0 01).Plasma cortisol levels were significantly increased at 60min after incision in all four groups ( P< 0 01),especially in group C 1 and C 2.There were no significant changes in plasma IL 6 levels in four groups perioperatively.Conclusion The effect of multi model analgesia is less than that of single model on glucose metabolism and rehailitation.