小儿术后持续静脉镇痛对上腹部手术应激反应的影响  

Effects of continuous intravenous postoperative analgesia on stress reaction in pediatric patients undergoing upper abdominal surgery

作　　者：任同悦[1] 唐明霞[1] 于宝金[1] 陈菲[1] 陈健[1] 强万党[1] 

机构地区：[1]天津市第四中心医院麻醉科,天津300140

出　　处：《河北医学》2002年第7期592-593,共2页Hebei Medicine

摘　　要：目的 :观察术后持续静脉镇痛对小儿上腹部手术应激反应的影响。方法 :30例患儿在静吸复合全麻下行剖腹探查术 ,随机分为术后镇痛组 (S组 )和对照组 (D组 )。于麻醉前、术中 90min、术毕 6 0min和术后 1、2、3d测定血糖、胰岛素及皮质醇浓度。结果 :两组患儿血糖均自术中 90min时明显升高 ,术毕 6 0min达峰值 ,术后 1、2d仍居高不下 (P <0 .0 5或P <0 .0 1)。S组术中及术后胰岛素水平无明显改变 ;D组术后 1、2d胰岛素水平升高明显 (P <0 .0 5或P <0 .0 1)。S组和D组患儿皮质醇都于术毕 6 0min时明显升高 (P <0 .0 5 ) ,而S组在术后 1d即恢复麻醉前水平 ,D组持续到术后 1、2d(P <0 .0 5 )。结论 :小儿术后持续静脉镇痛可缓解上腹部手术应激反应 。Objective :To investigate the effect of continuous intravenous postoperative analgesia on stress reaction in pediatric patients undergoing upper abdominal surgery.Methods: Thirty ASA Ⅰor Ⅱ pediatric patients under general anesthesia were randomly divided into two groups. Patients in S group receive postoperatively while in the control group did not.The levels of blood glucose,plasma insulin and cortisol were observed at five time points:before anesthesia,at 90min after incision,at 60min after the end of surgery,on the 1st,2nd and 3rd postoperative days.Results:The levels of blood glucose were increased significantly at 90min after incision and kept at the high levels till the 2nd postoperative day in both groups(P<0.01or P<0.05).The levels of plasma insulin were significantly elevated on the 1st and 2nd postoperative days (P<0.01 or P<0.05)in the D group,but not in S group.The levels of plasma cortisol in both groups increased significantly at 60min after the end of surgery(P<0.05).The levels of the plasma cortisol on the 1st postoperative day in S group recovered that of before anesthesia.The levels of the plasma cortisol was still higher on the 2nd postoperative day in D group(P<0.05). Conclusion: The continous intravenous postoperative analgesia may alleviate the stress response to upper abdominal surgery and the disturbance of glucose metabolism.

关 键 词：上腹部手术 术后持续静脉镇痛 应激反应 儿童 

分 类 号：R726.1[医药卫生—儿科]