硬膜外自控镇痛对结直肠手术患者术后疼痛及胃肠激素的影响观察

Effect of Patient-controlled Epidural Analgesia on Postoperative Pain and Gastrointestinal Hormones in Patients Undergoing Colorectal Surgery

目的:探讨硬膜外自控镇痛(patient controlled epidural analgesia,PCEA)对结直肠手术患者术后疼痛以及胃肠激素的影响,以期为临床治疗提供参考。方法:选取2019年3月-2020年3月在本院行结直肠癌根治术的83例患者为研究对象,根据随机数字分配的原则分为PCEA组42例和静脉自控镇痛(patient-controlled intravenous analgesia,PCIA)组41例。术后,PCEA组采用硬膜外自控镇痛,PCIA组采用静脉自控镇痛。比较两组患者术后2、6、12、24、48 h的VAS疼痛评分,术后肠功能恢复情况,术前和术后24、48 h的胃肠激素水平以及不良反应发生情况。结果:两组患者术后6 h疼痛达最高点。PCEA组术后2、6、12、24 h的VAS疼痛评分均低于PCIA组(P<0.05),而两组术后48 h的VAS疼痛评分比较,差异无统计学意义(P>0.05)。PCEA组术后排气时间、排便时间、进水时间以及进食时间均短于PCIA组(P<0.05)。术后24、48 h,PCEA组患者的GAS、MTL均高于PCIA组(P<0.05),VIP均低于PCIA组(P<0.05)。PCEA组患者不良反应发生率为16.67%,低于PCIA组的36.59%,差异有统计学意义(P<0.05)。结论:硬膜外自控镇痛对结直肠癌患者术后镇痛效果好,且有效改善胃肠功能的紊乱,更有利于患者术后胃肠功能恢复,临床上值得参考。

Objective:To investigate the effects of patient-controlled epidural analgesia(PCEA)on postoperative pain and gastrointestinal hormones in patients undergoing colorectal surgery,in order to provide reference for clinical treatment.Method:A tootal of 83 patients with colorectal cancer who underwent radical resection in our hospital from March 2019 to March 2020 were selected,they were divided into PCEA group(42 cases)and patient-controlled intravenous analgesia(PCIA)group(41 cases),according to the principle of random number allocation.PCEA group was given PCEA,PCIA group was given PCIA.VAS pain scores at 2,6,12,24,48 h after operation were compared between the two groups,the recovery of intestinal function,the levels of gastrointestinal hormones before operation,24 h and 48 h after operation,and the incidence of adverse reactions were analyzed between the two groups.Result:The pain reached the highest point 6 h after operation in both groups.The postoperative pain scores of PCEA group at 2,6,12 and 24 h were lower than those of PCIA group(P<0.05),and there was no significant difference in VAS scores 48 h after surgery between the two groups(P>0.05).Postoperative exhaust time,defecation time,water intake time and feeding time in PCEA group were all shorter than those in PCIA group(P<0.05).24 and 48 h after surgery,GAS and MTL in PCEA group were higher than those in PCIA group(P<0.05),VIP were lower than those of PCIA group(P<0.05).The incidence of adverse reactions in PCEA group was 16.67%,which was lower than 36.59%in PCIA group,the difference was statistically significant(P<0.05).Conclusion:PECA has good postoperative analgesia effect in patients with colorectal cancer,and effectively improves gastrointestinal function disorders,and is more conducive to postoperative gastrointestinal function recovery,which is worthy of reference in clinical practice.