颅脑手术围术期多模式镇痛的临床观察及其脑保护作用研究  

Brain Surgery Perioperative Clinical Observation of Multimodal Analgesia and its Effect on the Brain Protection

作　　者：朱国文[1] 赵敏[1] 王钱东[1] 

机构地区：[1]浙江省瑞安市人民医院麻醉科,325200

出　　处：《医学研究杂志》2014年第9期113-115,共3页Journal of Medical Research

摘　　要：目的 观察颅脑手术围术期多模式镇痛的临床疗效及其对机体应激反应的影响。方法 将笔者医院择期开颅手术患者60例,随机平均分为A、B、C3组,镇痛方法：A组：术后单独予PCIA（舒芬太尼2μg/kg＋昂丹司琼16mg＋生理盐水至100ml）镇痛。B组：手术开始前20min静脉滴注帕瑞昔布钠（特耐）40mg,术后镇痛同A组。C组：在B组的基础上以0.5％罗哌卡因作手术切口浸润麻醉。患者PCA镇痛泵设定持续输注背景流量2ml/h,PCA每次0.5ml,锁定时间15min,最大用药背景4ml/h。术后1、18、24和48h观察并比较静态疼痛视觉模拟评分（VASr）、动态疼痛视觉模拟评分（VASm）：镇痛效果0分为无痛,10分为最痛,警觉/镇静（OAA/S）评分（0～5分）,并计算PCA有效按压次数。于术前,切皮后10min及术毕抽取动脉血测定血糖。分别于麻醉诱导前、术后1、24、48h采集静脉血4ml,检测白细胞介素-6（IL-6）。结果 术中血糖A组升高最为显著,C组血糖升高不明显,与A组比较差异有统计学意义（P＜0.05）。3组患者随着PCIA时间延长,VASr和VASm评分呈下降趋势,在术后48h点,C组显著低于A组（P＜0.05）,术后48h内PCA有效按压次数C组明显低于A、B组（P＜0.05）,差异有统计学意义。术后各时点C组IL-6含量显著低于A、B组,B组明显低于A组,差异有统计学意义（P＜0.05）。结论 围术期多模式镇痛应用于颅脑外科手术在充分镇痛的同时且有利于降低机体应激反应,保护脑组织,且安全可行。Objective To observe the cerebral surgery perioperative clinical curative effect of multimodal analgesia and its effects on the body＇s stress response.Methods Sixty patients with elective surgical operation,are divided into three groups,group A：postoperative separately to the PCIA （sufentanil 2pg/kg,Dan SiQiong 16mg ＋ saline to 100ml） analgesia.Group B：20 minutes before the surgery,the static note paranal yesterday cloth （resistance） 40mg of sodium,postoperative analgesia with group A.Group C：on the basis of group B with 0.5％ ROM pp paid for incision infiltration anesthesia.Patients with PCA analgesia pump set continuous infusion background flow 2ml/h,PCA every 0.5ml,locking time 15min,the largest drug use background 4ml/h.Looked at 1,18,24 and 48h after surgery to observe and compare the static visual analog pain score （VASr）,dynamic visual analog pain score （VASm）：analgesic effect of 0 is divided into painless,10 is divided into the pain,and alert/sedation （OAA/S） score （0-5 points）,and calculate the PCA effective pressure.Before operation,10 minutes after cutting skin extract determination of arterial blood glucose and finish.Respectively before anesthesia induction,postoperative 1,24 and 48h venous blood was collected 4 ml,detection of interleukin 6 （IL-6）.Results The intraoperative blood glucose group A rise in the most significant,increase in blood sugar group C is not obvious,the difference was statistically significant compared with group A （P ＜ 0.05）.Three groups of patients with A prolonged PCIA VASr and VASm score is on the decline,48 hours after surgery,group C was significantly lower than that of group A （P ＜ 0.05）,postoperative within 48 h of PCA effectively on the number of group C was lower than that in group A and B （P ＜ 0.05）,with statistical significance.Each point group C after IL-6 content is significantly lower than group A,B,group B was lower than that in group A,compare the difference was statistically significant （P ＜ 0.05）

关 键 词：颅脑手术 多模式镇痛 围术期 脑保护 

分 类 号：R651[医药卫生—外科学]