多模式镇痛对老年人腹腔镜快通道术后应激反应的影响*

Multimodal analgesia on postoperative stress response in elderly patients with laparoscopic rapid passage*

摘要:

目的   探讨多模式镇痛对老年人腹腔镜快通道手术后应激反应的影响，比较不同镇痛模式的术后镇痛效果。方法   选择2014年3月-2015年8月60岁以上的择期手术患者80例，随机分为A、B两组（n =40）：A、B组患者均于术前给予凯纷（氟比洛芬酯注射液）2.00 mg/kg行超前镇痛；A组患者术后行硬膜外自控镇痛（PCEA），B组患者术后行静脉自控镇痛（PCIA）。A组与B组术后镇痛均于术毕拔除气管导管后5 min开始使用。比较两组手术前后平均动脉压（MAP）、心率（HR）、血糖值和皮质醇浓度等指标，以及术后视觉模拟疼痛评分（VAS）与不良反应的发生情况。结果   在术后6及24 h，A组VAS疼痛评分明显低于B组（P <0.05）；与B组比较，A组的血糖、皮质醇、MAP以及HR水平在术后6 h明显较低（P <0.05），且在术后24 h，A组的血皮质醇水平仍明显低于B组（P <0.05）；此外，A组老年病患在术后呕吐、头晕和嗜睡等不良反应发生情况明显低于B组（P <0.05）。结论   凯纷超前镇痛复合硬膜外术后镇痛模式比复合静脉术后镇痛模式更适用于老年腹腔镜快通道患者术后镇痛，值得临床推广和应用。

Abstract:

Objective To investigate the effect of multiple-modal analgesia on the stress response in elderly patients undergoing laparoscopic surgery, and compare the analgesic effect of different multimodal scheme. Methods Eighty patients aged over 60 were recruited in this study from Mar 2014 to Aug 2015. Patients were divided into two groups (n = 40). The patients in group A and B received Flurbiprofen (Flurbiprofen Axetil Injection), Flurbiprofen combined with patient-controlled epidural analgesia (PCEA) and Flurbiprofen combined with patient-controlled intravenous analgesia (PCIA), respectively. All patients were administered intravenously Flurbiprofen 2.00 mg/kg before operation, then, PCEA and PCIA were initiated for the patients in group A and B at the end of surgery. Preoperative and postoperative VAS pain score, glucose and cortisol, mean arterial pressure (MAP) and heart rate (HR) were assessed or measured. Results Compared with group B, the VAS score at 6 hours (T2) and 24 hours (T3) after surgery was significantly lower in group A (P < 0.05). Furthermore, in biological researches, we found that the level of glucose, cortisol, MAP and HR in group A were significantly lower than group B at 6 hours after surgery (P < 0.05), whereas, the cortisol level of group A was lower than group B up to T3 (P < 0.05). Also, less vomiting, dizziness and drowsiness were observed in group A than group B (P < 0.05). Conclusion The multiple-modal of analgesia Flurbiprofen combined with patient-controlled epidural analgesia is more suitable to elderly patients undergoing laparoscopic surgery , and it is worthy of clinical application and popularization.