高乌甲素超前镇痛对患者围术期应激反应及术后镇痛的影响

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英文篇名：Effect of Lappacontine Preemptive Analgesia on Perioperative Stress Response and Postoperative Analgesia 作者：张海霞 ; 申文 英文作者：ZHANG Haixia;SHEN Wen;Analgesia College of Xuzhou Medical University;The Affiliated Hospital of Xuzhou Medical University; 关键词：高乌甲素 ; 超前镇痛 ; 应激反应 ; 术后镇痛 英文关键词：lappaconitine;;preemptive analgesia;;stress response;;postoperative analgesia 中文刊名：XDJH 英文刊名：Modern Journal of Integrated Traditional Chinese and Western Medicine 机构：徐州医科大学麻醉学院;徐州医科大学附属医院; 出版日期：2017-04-01 出版单位：现代中西医结合杂志 年：2017 期：v.26 语种：中文; 页：XDJH201710009 页数：5 CN：10 ISSN：13-1283/R 分类号：31-34+72

摘要

目的探讨高乌甲素超前镇痛对经腹子宫切除患者围术期应激反应及术后镇痛的影响。方法选取ASAⅠ或Ⅱ级经腹子宫切除术患者60例,随机分为对照组、高乌甲素低剂量组和高乌甲素高剂量组各20例。均采用静吸复合麻醉,麻醉开始前30 min,高乌甲素低剂量组给予高乌甲素0.075 mg/kg稀释至20 m L静脉推注,高乌甲素高剂量组给予高乌甲素0.15 mg/kg稀释至20 m L静脉推注,对照组给予相同剂量生理盐水静脉推注,术毕均行自控静脉镇痛(PCIA)。3组分别于入室后(t_0)、气管插管即刻(t_1)、手术开始15 min(t_2)、气管拔管即刻(t_3)和术后24 h(t_4)抽取静脉血,测定皮质醇和儿茶酚胺水平,同时观察记录患者在术后2,4,6,8,12,24 h的VAS评分和Ramsay评分。结果 3组t_1、t_2、t_3时点血浆皮质醇和儿茶酚胺水平与t_0比较差异均无统计学意义(P均>0.05)。高乌甲素低剂量组和高乌甲素高剂量组t_4时点皮质醇、儿茶酚胺水平和术后各时点VAS评分均明显低于对照组(P均<0.05),且高乌甲素高剂量组t_4时点皮质醇和儿茶酚胺水平和术后各时点VAS评分均明显低于高乌甲素低剂量组(P均<0.05)。高乌甲素低剂量组和高乌甲素高剂量组术后2,4,6 hPCIA泵有效按压次数均明显少于对照组(P均<0.05),且高乌甲素高剂量组明显少于高乌甲素低剂量组(P均<0.05)。结论高乌甲素超前镇痛可以降低围术期患者皮质醇、儿茶酚胺水平,抑制围术期应激反应,减轻患者术后疼痛。
        Objective It is to analyze the effect of lappa-conitine preemptive analgesia on perioperative stress response and postoperative analgesia of patients with abdominal hysterectomy. Methods 60 patients with ASA Ⅰ or Ⅱ who were performed abdominal hysterectomy were enrolled in this study. All patients were treated with intravenous inhalation anesthesia and were randomly divided into 3 groups( n = 20 in each group) : control group( group C),low dose group( group Ⅰ) and high dose group( Group Ⅱ). ECG,Sp(O_2),PETCO_2,SBP,DBP were monitored and upper limb vein was opened. Lappaconitine0. 075 mg/kg and 0. 15 mg/kg were all diluted to 20 m L as well as normal saline 20 m L and then by intravenous injection distributed to group Ⅰ and Group Ⅱ respectively. At same time,group C was given the same dose of normal saline by intravenous injection as well. After operation,PCIA was performed. Venous blood were gathered from all groups after the burglary( t_0),tracheal intubation immediately( t_1) and surgery began 15 minutes( t_2),tracheal extubation immediately( t_3) and postoperative 24 hours( t_4),respectively,for the plasmic content detection of cortisol and catecholamine. At same time,the VAS score and Ramsay score in the postoperative 2,4,6,8,12,24 hours were also observed. Results There was no statistical significance in cortisol and catecholamine at t_1,t_2,t_3 of group C、group Ⅰ and group Ⅱ compared with t_0( P > 0. 05). However,compared with group C,the level of cortisol and catecholamines at t_4 were significantly lower and VAS score were significantly decreased in group Ⅰ and group Ⅱ( P < 0. 05). Compared with group Ⅰ,the level of cortisol and catecholamines at t_4 were significantly lower and VAS score swere significantly decreased in group Ⅱ( P < 0. 05). Compared with group C,PCIA effective pressing times after 2,4,6 h were significantly decreased in group Ⅰ and group Ⅱ( P < 0. 05). Compared with group Ⅰ,PCIA effective pressing times after 2,4,6 h were significantly decreased in group Ⅱ( P < 0. 05). Conclusion Lappaconitine preemptive pain can reduce the levels of cortisol and catecholamine of perioperative patients,inhibit perioperative stress response and reduce postoperative pain.

引文

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