静脉超前镇痛对以尿道前列腺气化电功手术患者围术期应激反应的影响  

Effect of venous pre-emptive analgesia on the stress in patients undergoing transtuethral electrovaporization of the prostate

作　　者：韩威[1] 郭宝富[1] 李龙云[1] 叶虹[1] 

机构地区：[1]吉林大学中日联谊医院麻醉科,吉林长春130033

出　　处：《中国实验诊断学》2009年第8期1077-1079,共3页Chinese Journal of Laboratory Diagnosis

摘　　要：目的探讨静脉超前镇痛对前列腺气化电切手术患者围术期血浆去甲肾上腺素、皮质醇、C-反应蛋白和血流动力学的影响。方法选择ASAⅠ-Ⅱ级择期行前列腺气化电切手术患者40例,随机分为2组:超前镇痛组(实验组20例)和术后镇痛组(对照组20例)。两组均采用腰硬联合阻滞麻醉。手术方式为经膀胱镜经尿道前列腺气化电切。PCIA镇痛制:舒芬太尼40μg,芬太尼400mg,曲马多400mg,稀释至100ml。负荷量舒芬太尼10μg,曲马多100mg。冲击量1.5ml,持续背景量2ml/h,锁定时间10min。实验组于患者入室10分钟后麻醉操作前开始静脉负荷量和背景量,对照组于术毕开始PCIA镇痛,方法同实验组。于入室后10分钟(T0)、手术开始后10分钟(T1)、术毕(T2)、手术当天16:10时(T3)、次日6:00(T4)时采集血样,测去甲肾上腺素、皮质醇、C反应蛋白;同时记录各时点心率、血压。结果实验组较对照组循环稳定,SBP、DBP、HR低于对照组(P<0.05);两组T1、T2、T3、与T0相比血浆去甲肾上腺素、皮质醇、C-反应蛋白升高(P<0.05),对照组T1、T2、T3时点血浆去甲肾上腺素、皮质醇、C-反应蛋白高于实验组(P<0.05)。结论将常规的PCIA镇痛提前,降低周围神经及中枢神经兴奋性,抑制中枢性和周围性致敏,减少了应激激素分泌,并始患者围术期循环稳定。Objective To investigate the effect of venous pre-emptive analgesia on perioperative blood level of NE, COS and CRP. Methods 40 ASA lo or 11 class patients undergoing transurethral eleetrovaporization of the prostate were randomlyy divided into two groups： the study group（ n = 20）and the control group（ n = 20）. the tow groups received combined spinat-epidural block. In the study group, patients received venous analgesia before anesthesia induction and operation, in the control group, patients received venous analgesia when operation is over. Blood NE, COS and CRP were observed perioperatively. Results in he study group, MAP, HR,NE, COS, CRP were significantly lower after the venous pre-emptive analgesia than them in the control group （ P 〈 0.05）, Conclusion Venous pre-emptive analgesia can effectively inhibit the stress response in patients undergoing transurethral electrovaporization of the prostate.

关 键 词：经尿道前列腺气化电切术 超前镇痛 应激反应 

分 类 号：R614[医药卫生—麻醉学]