体表电刺激对麻醉与镇痛患者应激反应的影响  

Stress effects of transcutaneous electric nerve stimulation on the anesthesia and postoperative analgesia with PCEA.

作　　者：肖辉[1] 佘守章[1] 刘春容[1] 

机构地区：[1]广州市第一人民医院麻醉科

出　　处：《华中医学杂志》2003年第4期181-182,184,共3页Central China Medical Journal

摘　　要：目的　观察体表电刺激对麻醉与镇痛患者应激反应的影响。方法　选择经腹子宫切除术患者 6 0例 ,随机分成三组 ,每组 2 0例。A组 :于术前经体表电刺激 30min ,术中持续电刺激 ,术后第 4h、8h再电刺激二次 ,每次 30min ,术后行硬膜外患者自控镇痛 (PCEA) ;B组 :单纯行术后PCEA ;C组 :不行PCEA。观察患者术中、术后血糖和皮质醇的变化 ,术后随访镇痛效果及不良反应等情况。结果　A组患者术中血糖显著升高的时间明显推后 (P <0 .0 5 ) ,升高的幅度较小 ,术后A、B组PCEA镇痛效果满意 ,镇痛期间血皮质醇浓度呈下降趋势 ,其中A组术后 8h下降的幅度大于B、C组 (P <0 .0 5 )。结论　联合应用体表电刺激 ,可有效减轻术中。Objective To evaluate the stress effects of Han's acupoint nerve stimulator (Han's) on the anesthesia and postoperative patient controlled epidural analgesia (PCEA).Methods Sixty patients with ASAⅠ～Ⅱ undergoing hysterectomy were randomly divided into three groups ( n =20 each) according to postoperative analgesia used: group A (Han's and PCEA); group B (PCEA only) and group C (pethidine intramuscular). The serum cortisol and glucose levels, VAS scores, Ramsay scores, Bruggrmann comfort scale, dosage of analgesia, and complications were observed.Results In group B and group C, the levels of blood glucose were significantly increased during the period of surgery and remained after the termination of operation. In group A, however, the increased blood glucose was found only at 5 min after surgery and was significantly lower than that of the control ( P < 0.05 ). The levels of serum cortisol were significantly increased in the three groups ( P < 0.01 ). There were no differences among three groups. The serum cortisol levels were decrease in both PCEA groups, but the level was lower in group A than in control group 8 h after operation ( P < 0.05 ).Conclusion Transcutaneous electric nerve stimulation combined with epidural analgesia and PCEA can suppress the stress related hormonal responses in patients after hysterectomy.

关 键 词：体表电刺激 麻醉 镇痛效果 应激反应 硬膜外自控镇痛 PCEA 生命体征 

分 类 号：R614[医药卫生—麻醉学]