硬膜外超前镇痛对上腹部手术病人应激反应的影响  

Effect of pre-emptive epidural analgesia on stress response to upper abdominal surgery

作　　者：王红梅[1] 周海燕[1] 

机构地区：[1]浙江大学医学院附属第二医院麻醉科,杭州市310009

出　　处：《中华麻醉学杂志》2009年第9期777-779,共3页Chinese Journal of Anesthesiology

基　　金：浙江省教育厅科研计划项目（20061399）

摘　　要：目的比较硬膜外超前镇痛和术后硬膜外镇痛对上腹部手术病人应激反应的影响。方法择期全麻下拟行上腹部手术的病人30例，ASA I或Ⅱ级，随机分为2组（n=15）：术后硬膜外镇痛组（c组）和硬膜外超前镇痛组（P组）。于T10，11间隙行硬膜外穿刺并置管。P组切皮前20min时硬膜外注射0．5μg／ml舒芬太尼＋0．15％罗哌卡因混合液15ml，30min后接镇痛泵，以5ml／h的速率硬膜外输注250ml。C组病人术后硬膜外注射0．5μg／ml舒芬太尼＋0．15％罗哌卡因混合液15ml，30min后接镇痛泵，以5ml／h的速率硬膜外输注250ml。于硬膜外穿刺前（T0）、术后2h（T1）和18h（T2）时，采集静脉血样6ml，测定血浆促肾上腺皮质激素（ACTH）浓度和血清皮质醇（Cor）、C反应蛋白（CRP）的浓度。结果与T0时比较，两组T1和T2时血清Cor、CRP的浓度和血浆ACTH浓度均升高（P〈0．01）；与C组比较，P组E和己时血清Cor、CRP的浓度和血浆ACTH浓度均降低（P〈0．05）。结论与术后硬膜外镇痛相比，硬膜外超前镇痛可更好地抑制上腹部手术病人术后应激反应。Objective To compare the effects of pre-emptive epidural analgesia and postoperative epidural analgesia on stress response to upper abdominal surgery. Methods Thirty ASA I or II patients undergoing eleetive upper abdominal surgery performed under general anesthesia were randomly divided into 2 groups （ n = 15 each） ： 1 pre-emptive epidural analgesia group （group P） and II postoperative epidural analgesia group （group C）. A mixture of 0.5 μg/ml sufentanil and 0.15% ropivacaine 250 ml was used for epidural analgesia in both groups. The epidural catheter was placed at T10-11 interspace. The epidural regimen included a loading dose of 15 ml followed after 30 min by continuous epidural infusion at 5 ml/h for 50 h. In group P the epidural analgesia was started at 20 min before skin incision, while in group C after operation when the patients emerged from general anesthesia and were extubated. The depth of general anesthesia was monitored using CSI and maintained at 45-55. Venous blood samples were taken before epidural catheter was placed （T0 ,baseline）, at 2 h （T1） and at 18 h （T2） after operation for determination the concentrations of ACTH and cortisol （Cor） and C reaction protein （CRP）. Results Blood Cor, ACTH and CRP concentrations were significantly increased after operation as compared with the baseline values at T0 and were significantly lower at T1 and T2 in group P than in group C. Conclusion Pre-emptive epidural analgesia can more effectively inhibit stress response than postoperative epidural analgesia to upper abdominal surgery.

关 键 词：镇痛 硬膜外 应激 

分 类 号：R614[医药卫生—麻醉学]