腰硬联合麻醉后曲马多PCEA对产妇血浆胃动素和肠道排气功能的影响

Effects of Patient Control Epidural Analgesia after Combined Spinal-epidural Anaesthesia with Tramadol on Plasma Motilin and Gastrointestinal Function of the Post-operation Puerperae

目的:观察罗哌卡因腰硬联合麻醉剖宫产后用曲马多进行病人硬膜外自控镇痛(PCEA)对产妇血浆胃动素及胃肠功能的影响。方法:60例ASA Ⅰ-Ⅱ级择期剖宫产孕妇,双盲随机分为2组:P组(n=30)罗哌卡因腰硬联合麻醉手术后以1％曲马多进行PCEA;N组(n=30)为对照组,即腰硬联合麻醉手术后未进行镇痛。结果:麻醉后P组和N组的血浆胃动素水平呈逐步下降趋势,术后4 h呈显著性下降(P<0.01),至术后12 h两组的胃动素水平均呈现回升接近术前水平,组间无显著性差异(P>0.05)。肛门排气时间,P组比N组有提早趋势(P<0.05)。结论:腰硬联合麻醉时胃肠道功能有抑制作用,手术创伤对胃肠功能恢复也有影响。术后应用1％曲马多PCEA并不延长麻醉对胃肠道功能的抑制时间。

Objective: To investigate the effects of patient control epidural analgesia ( PCEA) with tramadol after combined spinal - epidural anaesthesia on plasma motilin and gastrointestinal function of the post - operation puerperae. Method: Sixty patients ( ASA Ⅰ - Ⅱ ) undergoing cesarean section were randomly divided into 2 groups double -blindly to be treated with 1% tramadol PCEA in group P(n = 30) or without PCEA in group N(n =30). Result: In both groups, the plasma motilin level decreased after operation. At 4th hour after operation the decrease became significant( P <0. 01 ) ,and after twelve hours the motilin level returned to preoperational level. Then there was no difference between two groups ( P > 0. 05). Flatus passing was early in group P than in group N ( P < 0. 05 ). Conclusion: Both combined spinal - epidural anaesthesia and operation inhibited the gastrointestinal function, while PCEA with 1% tramadol did not prolong this inhibition.