芬太尼复合罗哌卡因硬膜外超前镇痛对患者围术期应激反应的影响  

Effects of fentanil combined with ropivacaine preemptive epidural analgesia on stress response in man

作　　者：程平瑞[1] 董静毅[1] 黄政通[1] 郭秀仪[2] 黄芳[1] 梁健华[1] 何颖宜[1] 

机构地区：[1]广州市番禺区人民医院麻醉科,511400 [2]广州市番禺区人民医院检验科,511400

出　　处：《临床麻醉学杂志》2009年第8期664-666,共3页Journal of Clinical Anesthesiology

基　　金：广州市医药卫生科技项目(编号:2007-YB-251)

摘　　要：目的观察芬太尼复合罗哌卡因硬膜外镇痛对应激反应的影响。方法60例全麻上腹部手术患者随机均分为超前镇痛组(P组)和对照组(C组),两组均行硬膜外镇痛(PEA),镇痛药液均为5μg/ml芬太尼+0.15%罗哌卡因。P组切皮前20min硬膜外腔注入镇痛液15ml,接镇痛泵以3ml/h速度持续PEA;C组手术结束后开始PEA。于硬膜外穿刺前(T0)、术后2h(T1)及次日早晨8时(T2)测定血浆皮质醇(Cor)、促肾上腺皮质激素(ACTH)和C反应蛋白(CRP)浓度;记录术后2、6、12、24h的疼痛评分。结果T1时P组镇痛效果优于C组(P<0.05)。两组T1及T2时血浆Cor、ACTH和CRP含量均高于T0时(P<0.05);T1及T2时血浆Cor、ACTH和CRP含量P组均低于C组(P<0.05)。结论5μg/ml芬太尼复合0.15%罗哌卡因PEA可为上腹部手术患者提供良好的术后镇痛;硬膜外超前镇痛较硬膜外术后镇痛能更有效地抑制围术期应激反应。Objective To investigate the effects of fentanil combined with ropivacaine epidural preemptive analgesia on stress response. Methods Sixty patients undergoing selective upper abdominal surgery under general anesthesia were randomly allocated to two groups of P（with epidural preemptive analgesia） and C（with conventional postoperative epidural analgesia,PEA）. The analgesic solution consisted of 5μg/ml fentanyt plus 0, 15% ropivacaine. As preemptive analgesia, 15 ml of analgesics was epidurally infused at 20 min before surgery, which was followed by PEA of 3 ml/h in group P. Only PEA of 3 ml/h was performed, which started at the end of operation in group C. The concentrations of cortisol（Cor）,ACTH and C-reaction protein （CRP） were measured before epidural （T0）,at 2 （T1） and 24 h（T2 ） after surgery. The analgesia was evaluated at 2,6, 12 and 24 h after surgery,respectively . Results Analgesia was better in group P than that in group C at T1 （P〈 0.05）. The plasma concentrations of Cor, ACTH and CRP in two groups were significantly increased at T1 and T2 than those at To （P〈0.05） ,which were lower in group P than those in group C（P〈0. 05）. Conclusion PEA with 5 μg/ml fentanyl plus 0.15% ropivacaine can provide effective postoperative pain relieve, in which preemptive epidural analgesia is better in inhibiting the stress response to surgical iniury.

关 键 词：硬膜外镇痛 超前镇痛 应激反应 芬太尼 罗哌卡因 

分 类 号：R614[医药卫生—麻醉学]