摘要
目的 观察不同术后镇痛方法对开胸肺癌手术病人血浆中与应激有关的三种激素,即去甲肾上腺素(NE)、肾上腺素(E)和皮质醇(CORT)的影响。方法 30例,ASAⅠ～Ⅱ级择期肺切除术患者。随机分为两组,病人控制硬膜外镇痛(PCEA)和病人控制静脉镇痛(PCIA)。在术后第一、二、三天晨行镇痛视觉模拟评分法(VAS)评分。分别于麻醉前、术毕、术后第一天和术后第三天取静脉血,测定血浆NE、F和CORT浓度。结果 两组镇前效果无显著差异(P>0.05)。PCIA组病人术毕、术后第一天测NE和CORT明显升高(P<0.05),术后第三天恢复。在术后第一天测PCIA组病人NE明显高于PCEA组(P<0.05)。结论 PCEA组不仅可有效减轻术后痛,而且抑制开胸肺手术后存在的应激反应。
Objective To study the effects of postoperative analgesia methods on plasma concentration of stress - related hormones,including Norepinephrine( NE), epinephrine(E) and cortisol(CORT) in patients undergoing pneumonectomy. Methods Thirty patients, ASA grade Ⅰ-Ⅱ , scheduled for elective pneumoneclomy, were randomly divided into 2 groups, patient control epidural analgesia(PCEA) and patient control intravenous analgesia(PCIA) . VAS scores were measured at the first, second and third day after operation. Plasma NE, E and CORT concentrations were measured before anesthesia, at the end of operation, the first and third day after operation. Results VAS scores were similar in two groups( P > 0. 05) . NE and CORT concentration at the end of operation and the first and third day after surgery was significantly higher than those before anesthesia and the third day after surgery in PCIA group (P < 0.05) . NE concentration of PCIA group was significantly higher than that of PCEA group at the first day after surgery (P<0.05) . Conclusion PCEA can not only decrease postoperative pain, but also suppress the stress-related hormonal responses in patients after pneumonectomy.
