不同镇痛方式对胸导管颈外静脉吻合术患者血浆皮质醇和血糖的影响

摘要

目的 观察不同镇痛方式对胸导管颈外静脉吻合术患者血浆皮质醇(Cor)和血糖(Glu)的影响.方法 选择ASA Ⅰ或Ⅱ级行择期胸导管颈外静脉吻合术患者60例,随机均分为盐酸罗哌卡因组(R组)、氟比洛芬酯预处理组(F1组)和氟比洛芬酯后处理组(F2组).R组于手术结束前向切口内喷洒0.75%盐酸罗哌卡因4 ml,并在切口两侧注入0.75%盐酸罗哌卡因6 m1.F1组和F2组分别于麻醉诱导前5 min和手术结束前5 min静注氟比洛芬酯1.0 mg/kg.观察三组患者在麻醉前5 min(T0)、术后6 h(T1)、24 h(T2)、48 h(T3)、72 h(T4)的血浆Cor和Glu水平.记录T2～T4时使用镇痛药的患者比例和VAS.结果 与T0时比较,T1、T2时三组血浆Cor和Glu均显著升高(P＜0.05或P＜0.01),但R组和F2组升高幅度显著低于F1组(P＜0.05).T2时R组、T4时R组和F2组需要使用镇痛药的患者显著少于F1组(P＜0.05或P＜0.01).T2～T4时VAS差异无统计学意义.结论 胸导管颈外静脉吻合术患者使用罗哌卡因封闭治疗,能取得较好的镇痛效果,并能有效地抑制围术期应激反应.%Objective To observe the effects of different analgesia techniques on plasma cortisol and glucose in the patients undergoing lymph-veinanastomosis.Methods Sixty ASA I or Ⅱ patients requiring selective lymph-veinanastomosis were equally randomized into ropivacaine group (group R),flurbiprofen axetil preprocessing group (group F1 ) and flurbiprofen axetil postprocessing group (group F2).In group R, 0.75％ ropivacaine was injected with 6 ml into the two sides of incision and sprayed with 4 ml to incision before the end of operation.Flurbiprofen axetil 1.0 mg/kg was intravenous injected 5 minutes before the induction of anaesthesia in group F1 and 5 minutes before the end of operation in group F2, respectively.The plasma cortisol and glucose levels were measured at 5 min (T0) before anaesthesia and at 6 (T1), 24 (T2), 48 (T3) and 72 (T4) hours after the operation.The percentage of patients requiring analgetics and VAS at T2, T3, T4 were recorded.Results The plasma cortisol and glucose levels were higher at T1 and T2 than at T0 in all groups (P＜0.05 or P＜0.01), while the levels were lower in groups R and F2 than in group F1 at T1 and T2 (P＜0.05).The percentage of patients requiring analgetics were lower in group R at T2 and in groups R and F2 at T4(P＜0.05 or P＜0.01).There was no difference between the three groups in VAS at T2, T3 and T4.Conclusion Ropivacaine blockade treatment in patients undergoing lymph-veinanastomosis has better analgetic effects, and can effectively inhibit the stress reaction in perioperative periods.