高原地区不同镇痛方法对肝包虫内囊摘除术后镇痛效果及应激反应的影响  

Influence of Analgesia Methods on Analgesic Effect and Stress Response after Surgical Resection of Hepatic Cystic Echinococcosis in Plateau Regions

作　　者：石秀丽[1] 贾珍[1] 赵世军[1] 陈仲海[1] 李孔兵 SHI Xiuli;JIA Zhen;ZHAO Shijun;CHEN Zhonghai;LI Kongbing(Department of Anesthesiology,Affiliated Hospital of Qinghai University,Xining 810001,China)

机构地区：[1]青海大学附属医院麻醉科,西宁810001

出　　处：《解放军预防医学杂志》2018年第8期989-992,共4页Journal of Preventive Medicine of Chinese People's Liberation Army

基　　金：青海省科技厅项目(No.2015-ZJ-758)

摘　　要：目的观察高原地区囊性肝包虫手术后不同镇痛方法的镇痛效果和对机体应激反应的影响。方法选择ASAⅠ～Ⅱ级肝包虫手术患者200例。按术后镇痛方法分为硬膜外组(E组)和静脉组(I组),每组100例。麻醉诱导和维持均采用全身静脉麻醉方式。记录两组患者术后的疼痛强度、镇痛泵的按压次数及不良反应。分别于麻醉前、术后第1天、第3天检测血浆皮质醇、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)及肿瘤坏死因子-α(TNF-α)水平。结果 E组病人在术后24h内额外帕瑞昔布钠的用量明显低于I组(P<0.01),且术后48h内患者自控镇痛按压次数及无效按压次数明显小于I组(P<0.01),E组术后呼吸抑制发生率显著低于I组(P<0.01)。两组各时间点的血浆皮质醇、IL-6、IL-10及TNF-α水平比较无显著差异(P>0.05)。结论肝包虫内囊摘除术在术后24h内,硬膜外镇痛效果优于静脉镇痛效果,术后48h内硬膜外镇痛的呼吸抑制发生率较低。Objective To observe the influence of different analgesic methods on postoperative analgesic effect and stress responses in recipients of cystic hepatic echinococcosis surgeries in plateau regions.Methods Two hundred patients with ASAⅠ-Ⅱhepatic hydatid disease were selected and randomly divided into the epidural analgesia group（ group E） and the intravenous analgesia group（ group Ⅰ）,with 100 patients in each. The total intravenous anesthetic method was adopted during anesthesia induction and maintenance. The pain intensity,number of times the PCA pump was pressed and adverse reactions of patients in the two groups were recorded. Moreover,the levels of plasma cortisol,interleukin-6（ IL-6）,interleukin-10（ IL-10） and tumour necrosis factor-α（TNF-α） were observed before anesthesia and on the 1 stand 3 rdpostoperative day respectively. Results The extra usage of parecoxib sodium among patients of group E within 24 h was significantly smaller than in group Ⅰ（ P〈0.01）,so was the patients＇ number of times the PCA pump was pressed for self-control analgesia and the number of times of invalid pressing within 48 h after operation（ P〈0.01）. Besides,the incidence of respiratory depression in group E was obviously lower than that of group Ⅰ（ P〈0.01）. However,there was no significant difference in the levels of plasma cortisol,IL-6,IL-10 or TNF-α between the two groups at different time points.Conclusion Epidural analgesia is more effective than intravenous analgesia within 24 h of surgical resection of hepatic cystic echinococcosis,and the incidence of postoperative respiratory depression is relatively low.

关 键 词：高原地区 术后镇痛 应激反应 囊性肝包虫 

分 类 号：R535[医药卫生—内科学]