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经腹膜腔给局麻药对LC病人术后镇痛效果及应激反应的影响
作者:胡斌 陈慧裕 何亮  
单位:南医大二附院麻醉科
关键词:腹腔镜胆囊切除术 经腹膜腔给局麻药 罗哌卡因 术后镇痛 应激反应 
分类号:
出版年·卷·期(页码):2012·40·第一期(1-4)
摘要:

目的 观察腹腔镜胆囊切除术患者腹腔内应用局麻药的镇痛效果及它对血糖、皮质醇、胰岛素的影响。方法 60例LC患者随机分成三组,每组20例。Ⅰ和Ⅲ组分别于术前、术毕腹膜腔喷洒罗哌卡因;Ⅱ组喷洒生理盐水。记录术后6、24、48小时 VAS评分;于诱导前、拔管前、术后6、24、72小时取静脉血测血糖、皮质醇、胰岛素的浓度。结果Ⅰ、Ⅲ组术后6、24、48小时 VAS评分较Ⅱ组低(P<0.01),同时点Ⅲ组VAS评分较Ⅰ组低。与术前值比,各组拔管前、术后6、24小时皮质醇、血糖、胰岛素浓度均升高(P<0.01),Ⅰ、Ⅲ组术后第3天恢复到术前水平(P>0.05),Ⅱ组仍高于术前(P<0.01)。与Ⅱ、Ⅲ组相比,术后6小时Ⅰ组皮质醇浓度较低,有非常显著性差异(P<0.01),在术后24小时高于Ⅲ组。在术后24、72小时Ⅰ、Ⅱ组血糖比较无显著性差异(P>0.05),Ⅱ组血糖值高于Ⅲ组(P<0.01);Ⅰ、Ⅲ组在术后6小时、24小时、72小时血糖值组间无显著差异(P>0.05)。Ⅰ组术后6小时胰岛素浓度低于其它两组,有显著性差异(P<0.01),术后24小时Ⅲ组胰岛素低于Ⅰ、Ⅱ组,术后72小时Ⅰ、Ⅲ组胰岛素浓度差异无统计学意义(P>0.05)。结论 经腹膜腔给局麻药镇痛效果明显,术前给药体现了超前镇痛的效应。此方法可减轻LC手术的应激反应。

Objectives: To investigate the effects of postoperative analgesia with intraperitoneal local anesthetic and the changes of plasma cortisol, blood glucose, insuline on patients undergoing laparoscopic cholecystectomy(LC) .Methods: Sixty patients(ASAⅠ~Ⅱ) underging elective LC were randomly divided into there groups,there are 20 peoples every group.The patinets were received the analgesia with ropivacaine into intraperitoneal space before surgery(group Ⅰ)or at the end of operation (Group Ⅲ). Group Ⅱwas done it with 0.9%NaCl. Pain degree was measured using visual analog scale(VAS) at 6h, 24h and 48h after operation in three groups. Plasma cortisol, blood glucose and insuline concentrations were measured before anesthesia and extubaion, at 6h,24h and 72h after operation in three groups. Results: The postoperative pain: The VAS values in group Ⅰand Ⅲ were much lower than that in group Ⅱ(P<0.01), and the values in group Ⅲ were the lower than that in group Ⅰ. The plasma levels of cortisol,blood glucose and insuline were significantly increased after operation compared with those before operation in all three groups(P<0.01). It declined to preoperative level on the postoperative 3rd day in Ⅰand Ⅲ(P>0.05), but was still higer than the baseline level in groupⅡ(P<0.01). The plasma levels of cortisol were declined at 6h after operation in group Ⅰ compared with those in group Ⅱand Ⅲ(P<0.05). The plasma levels of cortisol was lower at 6h after operation in group Ⅰ than that in group Ⅲ, but was higher at 24h after operation in group Ⅰ than that in group Ⅲ.The blood glucose of Ⅰand Ⅱ have no significant difference at the 24,72h after operation(P>0.05).The plasma levels of blood glucose in group Ⅱ were much higher at 24h and 72h after operation than that in group Ⅲ(P<0.01), The blood glucose of Ⅰand Ⅲ have no significant difference at the 6h, 24,72h after operation(P>0.05).The plasma levels of insuline were declined at 6h after operation in group

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