不同麻醉方式下胃癌根治术后患者疼痛程度的比较  

Comparison of degree of pain in patients after radical gastrectomy under different anesthetic regimens

作　　者：吴一泉[1] 金周晟[1] 刘启敏[1] 夏芳芳[1] 刘付丽[1] 丁希丽[1] 董慧敏[1] 徐旭仲[1] 

机构地区：[1]温州医学院附属第一医院麻醉科,325000

出　　处：《中华麻醉学杂志》2012年第1期74-77,共4页Chinese Journal of Anesthesiology

摘　　要：目的．比较不同麻醉方式下胃癌根治术后患者的疼痛程度。方法择期拟行胃癌根治术患者102例，性别不限，ASA分级Ⅰ或Ⅱ级，年龄50～75岁，体重45～70奴，采用随机数字表法，将患者随机分为3组（n=34）：单纯全麻组（GA组）、全麻联合肋缘下腹横肌平面阻滞组（CGTA组）和全麻联合硬膜外阻滞组（CGEA组）。术后拔除气管导管后送至麻醉后恢复室（cPAcU），患者入室时记录VAS评分。PACU期间评价疼痛程度，VAS评分〉3分的患者接受静脉吗啡滴定，VAS评分≤3分时停止吗啡滴定，接静脉自控镇痛泵和，或硬膜外镇痛泵。滴定结束时记录吗啡总用量，观察不良反应的发生情况。结果与GA组和CGTA组比较，CGEA组术后中重度痛发生率降低（P〈0．01）；GA组、CGTA组和CGEA组患者术后重度痛发生率、入室时VAS评分及吗啡总用量依次降低（P〈0．01）；CGEA组镇静发生率低于GA组（P〈0．01），三组其余不良反应发生率比较差异无统计学意义（P〉0．05）。结论全麻、全麻联合肋缘下腹横肌平面阻滞和全麻联合硬膜外阻滞下胃癌根治术后患者的疼痛程度依次降低。Objective To compare the degree of pain in patients after radical gastrectomy under different anesthetic regimens. Methods One hundred and two ASA Ⅰ or Ⅱ patients of both sexes, aged 50-75 yr, weighing 45-70 kg, undergoing elective radical gastrectomy, were randomly divided into 3 groups （ n = 34 each） ： general anesthesia （GA） group, combined general-subcostal transversus abdominis plane block （CGTA） group and combined general-epidural anesthesia （CGEA） group. The patients were sent to the postanesthesia care unit （PACU） after tracheal extubation, and the VAS score On arrival in the PACU was recorded. The degree of pain was evaluated by VAS score, and when VAS scores 〉 3, the patients received intravenous morphine titration. When VAS scores ≤ 3, morphine titration was stopped and all the patients were connected to patient-controlled intravenous analgesia and/or epidural analgesia pump. The total amount of morphine consumed was recorded at the end of titration, and the occurrence of adverse reactions was also observed. Results Compared with groups GA and CG- TA, the incidence of moderate to severe postoperative pain was significantly decreased in group CGEA （P 〈 0.01 ）. The incidence of severe postoperative pain, the VAS score on arrival in the PACU and the total amount of morphine consumed were decreased gradually in groups GA, CGTA and CGEA （ P 〈 0.01 ）. The incidence of sedation was significantly lower in group CGEA than in group GA （P 〈 0.01 ）. There were no significant differences in the other adverse reactions among the three groups （ P 〉 0.05 ）. Conclusion The degree of pain is reduced gradually in patients after radical gastrectomy under GA, CGTA and CGEA.

关 键 词：麻醉 胃肿瘤 疼痛  手术后 

分 类 号：R614[医药卫生—麻醉学]