摘要
目的 观察硬膜外超前镇痛的临床效果及其对儿茶酚胺的影响。方法 4 8例手术患者随机分为三组 ,硬膜外穿刺后经硬膜外导管注入曲马多 1mg/kg(Ⅰ组 ) ,氯胺酮 2 0mg加曲马多 1mg/kg(Ⅱ组 ) ,对照组于术毕注入曲马多 1mg/kg(Ⅲ组 )。术后均采用硬膜外自控镇痛 (PCEA)。观察术后视觉模拟 (VAS)评分和不良反应 ,并比较血浆去甲肾上腺素 (NE)、肾上腺素 (E)、多巴胺 (DA)变化。结果 Ⅰ组与Ⅲ组相比 ,观察指标差异无显著意义 ,Ⅱ组与Ⅰ、Ⅲ组相比 ,VAS评分降低。三组患者儿茶酚胺含量术后第 1天均高于术前 (P <0 0 1) ,术后第 3天下降 ,Ⅱ组下降最明显 ,接近术前 ;Ⅰ组和Ⅲ组 ,仍明显高于术前 (P <0 0 5 )。结论 联合应用氯胺酮和曲马多行超前镇痛效果较好 。
Objective To investigate the effects of preemptive analgesia with epidural and to find out the influence on catecholamine(CA).Methods 48 patients undergoing surgery were divided randomly into 3 groups.Tramal 1mg/kg(group Ⅰ),ketamine 20mg plus Tramal 1mg/kg(group Ⅱ) were given epidurally before operation.In the control group,1mg/kg of tramal was given epidurally at the end of surgery.All patients were obtained PCEA after surgery.VAS score and incidences of side effect were observed,and plasma levels of E,NE,DA were mearsured.Results Group Ⅰ had no significant difference compared with group Ⅲ,the effect of group Ⅱ was better than group Ⅰ and group Ⅲ.Pain scores was lower.The first day after operation,level of serum CA elevated in 3 groups(P<0.01).On the third day,it remained higher than before operation in group Ⅰ and group Ⅲ(P<0.05),but there was no significant difference in group Ⅱ(P<0.01).Conclusion Preemptive analgesia with epidural ketamine plus tramal could relieve pain better and inhibit the stress response to the pain.
出处
《中国基层医药》
CAS
2004年第11期1324-1325,共2页
Chinese Journal of Primary Medicine and Pharmacy
