不同镇痛方式对腹腔镜下宫颈癌根治术后血液流变学的影响  

Effect of different analgesia methods on hemorheology in patients undergoing uterine cervix cancer radical surgery by laparoscopy

作　　者：耿桂启[1] 李泓[1] 李宁[1] 黄绍强[1] 

机构地区：[1]复旦大学附属妇产科医院麻醉科,上海200090

出　　处：《上海医学》2012年第8期675-677,共3页Shanghai Medical Journal

基　　金：上海市卫生局课题基金资助项目(2009030)

摘　　要：目的探讨不同镇痛方式对腹腔镜下宫颈癌根治术后血液流变学的影响。方法选择行腹腔镜下宫颈癌根治术的患者40例,随机分为患者自控硬脊膜外腔镇痛(PCEA)组和患者自控静脉镇痛(PCIA)组,每组20例。所有患者均在全凭静脉麻醉下手术。PCEA组患者在手术前进行硬脊膜外腔置管备用,术后给予罗哌卡因复合舒芬太尼镇痛;PCIA组患者采用舒芬太尼静脉镇痛。记录所有患者术中及术后第1和2天的输液量、出血量及尿量等,于术前及术后第1和2天采集静脉血检测血液流变学指标。结果 PCEA组在术后第1天的全血高切黏度、血浆黏度、红细胞变形指数均显著低于PCIA组(P值均<0.05)。PCEA组在术后第1天的所有血液流变学指标及术后第2天的血浆黏度、红细胞比容、红细胞变形指数、血浆纤维蛋白原水平均较麻醉前显著降低(P值均<0.05)。PCIA组在术后第1天的血浆黏度、红细胞变形指数、血浆纤维蛋白原水平均较麻醉前显著降低(P值均<0.05)。结论对于行腹腔镜下宫颈癌根治术的患者,硬脊膜外腔镇痛较静脉镇痛更有利于血液流变学指标的改善,可作为减少术后血栓性并发症的有效措施之一。Objective To evaluate the effect of different analgesia methods on hemorheology in patients undergoing uterine cervix cancer radical surgery by laparoscopy. Methods Forty female patients undergoing uterine cervix cancer radical surgery by laparoscepy were randomized to receive either patient-controlled epidural analgesia （PCEA group, n=20） or patient-controlled intravenous analgesia （PCIA group, n = 20）. In PCEA group, epidural catheter was placed before general anesthesia, and a mixture of ropivacaine and sufentanil was continuously infused after surgery. In PCIA group, sufentanil was continuously infused after surgery. Transfusion volume, bleeding volume and urine volume were recorded during surgery and at 1 d and 2 d after surgery. Blood samples were taken to test hemorheological index before anesthesia and at ] d and 2 d after surgery. Results High-shear-rate blood viscosity, plasma viscosity, and RBC deformation index in PCEA group were significantly lower than those in PCIA group at 1 d after surgery （P〈0.05）. In PCEA group, all the hemorheological indexes at 1 d after surgery and plasma viscosity, erythrocrit, RBC deformation index and plasma fibrinogen at 2 d after surgery were significantly lower than those before anesthesia （P〈0.05）. In PCIA group, plasma viscosity, RBC deformation index and plasma fibrinogen at 1 d postoperatively were significantly lower than those before anesthesia （P〈0.05）. Conclusion Epidural analgesia can improve the hemorheological parameters in patients undergoing uterine cervix cancer radical surgery. It can be used to effectively reduce thrombosis. （Shanghai Med J, 2012, 35： 675-677）

关 键 词：麻醉 镇痛 深静脉血栓 血液流变学 

分 类 号：R614[医药卫生—麻醉学]