摘要
目的探讨广泛子宫切除术患者较为理想的术后镇痛模式。方法择期行广泛子宫切除术患者30例,随机分为硬膜外(E)组、静脉舒芬太尼(S)组、静脉吗啡(M)组。术毕启动患者自控镇痛(PCA)。E组用(0.125%罗哌可因+0.5μg/mL舒芬太尼)硬膜外自控镇痛泵(总容量180 mL),背景剂量2 mL/h,PCA量2mL/次,锁定时间15min。S组用(0.75μg/mL舒芬太尼)静脉镇痛泵(总容量150mL),背景剂量2mL/h,PCA量2mL/次,锁定时间15min。M组用(吗啡0.5mg/mL)静脉镇痛泵(总容量100mL),背景剂量1mL/h,PCA量2mL,锁定时间6min。3组患者均于手术结束时,术后2h、24h分别采集肘静脉血4mL,测血清皮质醇、白细胞介素(IL)-6值。结果术后2h、24h所有患者血浆皮质醇、IL-6均降低,且E组、S组皮质醇值明显低于M组,但E组与S组间比较差异无统计学意义。术后2h、24hE组IL-6明显低于S组(P<0.05)。结论舒芬太尼复合罗哌卡因患者自控硬膜外镇痛(PCEA)和舒芬太尼患者自控静脉镇痛(PCIA)对于妇科广泛子宫切除术患者均明显抑制了皮质醇、IL-6的产生,抑制了手术创伤及疼痛所致机体过度的应激反应。
Objective To examine the safety and analgesic efficacy of epidural sufentanil ropivacaine,intravenous sufentanil and intravenous morphine administered by patient-controlled analgesia（PCA）in patients recovering from transabdominal extensive hysterectomy.Methods Thirty patients were randomized to one of three treatment groups：Group 1：postoperative patient-controlled epidural analgesia（PCEA）（n =10）with 0.125%ropivacaine/sufentanil 0.5μg/mL,2ml bolus followed by 2mL/h infusion plus epidural PCA boluses of 2mL every 15 min as needed;Group 2：postoperative patient-controlled intravenous analgesia（PCIA）（n =10）with sufentanil 0.75μg/mL,2mL bolus followed by 2 mL/h infusion plus Ⅳ PCA boluses of 2 mL every 15 min as needed;Group 3：postoperative PCIA（n=10）with morphine 0.5mg/mL,2mL bolus followed by 1mL/h infusion plusⅣ PCA boluses of 2mL every 10 min as needed;Blood samples were collected immediately at the moment of completion of surgery,2hand 24 hafter surgery from each patient to analyze concentrations of interleukin-6and cortisol.Results The cortisol value in ES group at 2,24 hfollowing analgesic administration were lower than those in M group（P〈0.01）;Compared with the values at the end of surgery,plasma concentration of cortisol in all groups at the 2,24 hour after surgery were lower.Plasma concentration of IL-6in E group at the 2,24 hour after surgery were lower than those in S group.Conclusion Three groups provided effective pain relief.The main advantage of PCA sufentanil in this postsurgical setting was its ability to reduce the secretion of cortisol more significantly,while epidural ropivacaine/sufentanil offering greater inhibitory effect on generation of postoperative interleukin-6thanⅣ sufentanil.
出处
《山西医药杂志》
CAS
2015年第3期260-263,共4页
Shanxi Medical Journal
关键词
子宫切除术
白细胞介素6
皮质醇
术后自控镇痛
Hysterectomy
Interleukin-6
Cortisol
Postoperative patient-controlled analgesia
