术后硬膜外镇痛对卵巢癌根治术病人血浆皮质醇的影响  

Effects of epidural analgesia on level of plasma corticosteroid in postoperative ovary cancer patients

作　　者：孙志华[1] 熊靖 郭曲练[1] 

机构地区：[1]中南大学湘雅医院麻醉科,湖南长沙410008 [2]江西省宜春市万载县中医院,江西宜春336100

出　　处：《中国现代医学杂志》2010年第21期3312-3313,3317,共3页China Journal of Modern Medicine

摘　　要：目的评价术后疼痛对卵巢癌根治术病人血浆皮质醇的影响,以探讨术后硬膜外(PCEA)镇痛减轻妇科手术后应激反应的效果。方法选择全麻下行卵巢癌根治术病人40例,年龄30～50岁,随机分为术后静脉镇痛组(Ⅰ组n=20)和术后硬膜外镇痛组(E组n=20)。记录术后VAS评分和不良反应。分别于麻醉诱导前(T1)、术后2 h(T2)、1d(T3)、3d(T4)、5d(T5)、7d(T6)时取外周静脉血样测定血浆皮质醇的浓度。结果两组血浆皮质醇浓度于术后2 h较麻醉诱导前明显升高(P<0.05),与静脉镇痛组比较,硬膜外镇痛组在术后2 h～3d时血浆皮质醇浓度降低(P<0.05)。结论术后硬膜外镇痛可在一定程度上抑制应激反应,其效果优于术后静脉镇痛。【Objective】 To investigate the effects of postoperative pain on plasma cortisol and epidural analgesia on reducing postoperative stress after ovarian surgery.【Methods】 Forty ASAⅠorⅡ patients aged 30~50 yr undergoing ovarian surgery performed under general anesthesia were randomly divided into 2 groups（n =20 in each）： groupⅠreceived postoperative epidural PCA（PCEA） with 0.15% ropivacaine＋fentanyl 10 μg/mL and groupⅡ received postoperative intravenous PCA（PCIA） with 10 μg/mL fentanyl.Postoperative analgesia began when ovarian surgery was finished.Visual Analgesia Scale（VAS） and side effects were evaluated after operation.Concentration of plasma cortisol was measured before induction and 2 h,1 d,3 d,5 d and 7 d after operation.【Results】 Level of plasma cortisol was significantly higher 2 h after operation than that before induction in all the patients（P 0.05）.But level of plasma cortisol 2 h to 3 d after operation was lower in group Ⅱ than in group Ⅰ（P 0.05）.【Conclusion】 PCEA may depress stress action after operation in some situation as compared to PCIA.

关 键 词：镇痛 硬膜外 疼痛 手术后 血浆皮质醇 

分 类 号：R614[医药卫生—麻醉学]