腹部手术后不同镇痛方法的镇痛效果及对儿茶酚胺的影响

Effect of different methods for postoperative pain management on catecholamine response to abdominal surgery

目的 :观察腹部手术后不同镇痛方法的镇痛效果及对儿茶酚胺的影响。方法 :4 2例选择性开腹手术患者 ,随机分为 5组 ,罗哌卡因芬太尼 (ropivacainefentanyl,RF)、布比卡因芬太尼 (bupivacainefentanyl,BF)、布比卡因吗啡 (bupivacainemorphine,BM )组术中 1.2g·L-1硬膜外复合全麻 ,术后持续硬膜外镇痛 ,镇痛药物分别为 1.2g·L-1罗哌卡因 + 2mg·L-1芬太尼、1.2g·L-1布比卡因 + 2mg·L-1芬太尼、1.2g·L-1布比卡因 + 80mg·L-1吗啡 ;EM组术中硬膜外复合全麻 ,术后持续静脉吗啡 0 .5 g·L-1镇痛 ;静脉吗啡 (intravenousmorphine,M )组术中单纯全麻 ,术后持续静脉吗啡 0 .5g·L-1镇痛。记录镇痛效果 ,测定麻醉前、术后 1h、术后 2 4h血浆肾上腺素和去甲肾上腺素水平。结果 :各组均可获得有效的镇痛效果。VAS评分BM组、M组显著低于RF组 ,VRS评分BM组明显高于RF、EM、M组。BM、M、EM组副作用较多 ,M组恶心发生率最高 (5例 )。术后 1hBM组肾上腺素显著低于BF组 ,EM组去甲肾上腺素明显低于RF组。术后 2 4hM组肾上腺素和去甲肾上腺素均高于术前。结论 :目前常用的硬膜外或静脉病人自控镇痛方法都有明确的镇痛效果 ,术中复合硬膜外阻滞或术后硬膜外镇痛可以显著减轻术后应激反应的程度 。

Objective: To observe the effect of different analgesic methods and the influence of catecholamine response to elective abdominal surgery. Methods: 42 ASAⅠ-Ⅱ patients undergoing elective abdominal surgery were randomly divided into five groups. After receiving combined general and epidural anesthesia, postoperative patient controlled epidural analgesia was provided in group RF,BF,BM with 1.2 g·L -1 ropivacaine+2 mg·L -1 fentanyl, 1.2 g·L -1 bupivacaine+2 mg·L -1 fentanyl, 1.2 g·L -1 bupivacaine+80 mg·L -1 morphine respectively. Group EM received general epidural anesthesia and patient controlled intravenous analgesia with 0.5 g·L -1 morphine. Levels of analgesics(VAS,VRS),plasma concentrations of adrenaline and noradenaline were measured. Results: Effective analgesia could be achieved in all groups. VAS in groups BM and M was significantly less than that in groups RF, and VRS in groups BM was higher than that in groups RF,EM and M. There were more side effects in groups BM,M and EM,and the incidence of nausea was highest in group M(5 cases). The adrenaline concentrations in group BM one hour postoperation was lower than that in group BF, and noradrenaline in group EM was lower than that in group RF.The 24 hour postoperative values of the adrenaline and noradrenaline in group M were higher than their preoperative values. Conclusions: Post operative patient controlled epidural or intravenous analgesia could provide effective analgesia.Epidural anesthesia during operation or epidural analgesia postoperation could depress stress responses, thus it is a more effective analgesic method.