国际医药卫生导报
國際醫藥衛生導報
국제의약위생도보
INTERNATIONAL MEDICINE & HEALTH GUIDANCE NEWS
2013年
7期
937-939
,共3页
超前镇痛%硬膜外镇痛%围术期%应激反应
超前鎮痛%硬膜外鎮痛%圍術期%應激反應
초전진통%경막외진통%위술기%응격반응
Preemptive analgesia%Epidural analgesia%Perioperative period%Stress reaction
目的 探讨PCEA(硬膜外自控镇痛术)超前镇痛对患者围术期应激反应的影响.方法 选择ASA I～Ⅱ级择期行上腹部手术患者80例,随机分为两组,超前镇痛组(A组)和术后镇痛组(B组),每组40例.镇痛药物均为0.7μg/ml舒芬太尼+0.15％罗哌卡因稀释至100 ml混合液.A组手术开始时负荷剂量为镇痛混合液10 ml,并接镇痛泵于背景剂量为2 ml/h持续镇痛；B组于术毕开始PCEA镇痛,方法同A组.两组患者分别于入室后10 min(T0),手术开始时(T1),术毕后2 h(T2)及次日6:oo (T3)采集静脉血样,测定皮质醇(COR)、促肾上腺皮质激素(ACTH)、C-反应蛋白(CRP).疼痛评分采用VAS评分标尺,观察并记录术后2h、6h、12h、24h疼痛评分.结果 两组患者术后各时段生命体征平稳,A组T2镇痛效果优于B组(P＜0.01),两组患者T1、T2、T3 COR、ACTH和CRP相比T0均明显升高(P＜0.0l),T1、T2、T3 B组COR、ACTH和CRP含量高于A组(P＜0.05).结论 0.7μg/ml舒芬太尼复合0.15％罗哌卡因PCEA超前镇痛和常规PCEA均可为上腹部手术患者提供良好的镇痛效果.PCEA超前镇痛相比常规PCEA更有效地抑制围术期应激反应.
目的 探討PCEA(硬膜外自控鎮痛術)超前鎮痛對患者圍術期應激反應的影響.方法 選擇ASA I～Ⅱ級擇期行上腹部手術患者80例,隨機分為兩組,超前鎮痛組(A組)和術後鎮痛組(B組),每組40例.鎮痛藥物均為0.7μg/ml舒芬太尼+0.15％囉哌卡因稀釋至100 ml混閤液.A組手術開始時負荷劑量為鎮痛混閤液10 ml,併接鎮痛泵于揹景劑量為2 ml/h持續鎮痛；B組于術畢開始PCEA鎮痛,方法同A組.兩組患者分彆于入室後10 min(T0),手術開始時(T1),術畢後2 h(T2)及次日6:oo (T3)採集靜脈血樣,測定皮質醇(COR)、促腎上腺皮質激素(ACTH)、C-反應蛋白(CRP).疼痛評分採用VAS評分標呎,觀察併記錄術後2h、6h、12h、24h疼痛評分.結果 兩組患者術後各時段生命體徵平穩,A組T2鎮痛效果優于B組(P＜0.01),兩組患者T1、T2、T3 COR、ACTH和CRP相比T0均明顯升高(P＜0.0l),T1、T2、T3 B組COR、ACTH和CRP含量高于A組(P＜0.05).結論 0.7μg/ml舒芬太尼複閤0.15％囉哌卡因PCEA超前鎮痛和常規PCEA均可為上腹部手術患者提供良好的鎮痛效果.PCEA超前鎮痛相比常規PCEA更有效地抑製圍術期應激反應.
목적 탐토PCEA(경막외자공진통술)초전진통대환자위술기응격반응적영향.방법 선택ASA I～Ⅱ급택기행상복부수술환자80례,수궤분위량조,초전진통조(A조)화술후진통조(B조),매조40례.진통약물균위0.7μg/ml서분태니+0.15％라고잡인희석지100 ml혼합액.A조수술개시시부하제량위진통혼합액10 ml,병접진통빙우배경제량위2 ml/h지속진통；B조우술필개시PCEA진통,방법동A조.량조환자분별우입실후10 min(T0),수술개시시(T1),술필후2 h(T2)급차일6:oo (T3)채집정맥혈양,측정피질순(COR)、촉신상선피질격소(ACTH)、C-반응단백(CRP).동통평분채용VAS평분표척,관찰병기록술후2h、6h、12h、24h동통평분.결과 량조환자술후각시단생명체정평은,A조T2진통효과우우B조(P＜0.01),량조환자T1、T2、T3 COR、ACTH화CRP상비T0균명현승고(P＜0.0l),T1、T2、T3 B조COR、ACTH화CRP함량고우A조(P＜0.05).결론 0.7μg/ml서분태니복합0.15％라고잡인PCEA초전진통화상규PCEA균가위상복부수술환자제공량호적진통효과.PCEA초전진통상비상규PCEA경유효지억제위술기응격반응.
Objective To explore the effect of preemptive analgesia with PCEA on stress reaction in patients at perioperative period.Methods 80 ASA grades I and Ⅱ patients scheduled for upper abdominal surgery were randomly divided into two groups:preemptive analgesia group (group A) and postoperative analgesia group (group B),40 for each group.Mixed solution of 100 ml with sufentanil of 0.7 ug/ml and ropivacaine of 0.15％ was used for analgesia.Group A received mixed solution with an initial loading dose of 10 ml and continuous analgesia with a background dose of 2 ml/h using an analgesic pump; while group B received analgesia with PCEA postoperatively with the same method used in group A.Levels of cortisol (COR),adrenocorticotropic hormone (ACTH),and C-reactive protein (CRP) were measured in the two groups at l0 minutes after entering into the operating room (To),the beginning of surgery (T1),2 hours after surgery (T2),and 6 am on the next day (T3).Pain scores were recorded at hours 2,6,12,and 24 after surgery with VAS rating scale.Results Vital signs were stable in both groups at different periods.The effect of analgesia was better in group A than in group B at T2 (P＜0.01).Levels of COR,ACTH,and CRP were significantly increased in both groups at T1,T2 and T3,as compared with T0 (P＜0.01).Levels of COR,ACTH and CRP were significantly higher in group B than in group A at T1,T2,and T3 (P＜0.05).Conclusions Preemptive analgesia with PCEA using sufentanil of 0.7 ug/ml and ropivacaine of 0.15％ and conventional analgesia with PCEA have better analgetic effect in patients undergoing upper abdominal surgery.Preemptive analgesia with PCEA is more effective in control of stress reaction at at perioperative period than conventional analgesia with PCEA.
