【摘要】 目的　评价三种止痛模式对上腹部手术应激反应的抑制程度 ,寻求更为合理的止痛方法。方法　根据止痛方法不同 ,将 30例胆囊切除术病人分为三组 :术后静脉吗啡止痛组 (M组 ,n =10 ) ,术后硬膜外止痛组 (E组 ,n =10 ) ,及术前可乐定联合术后硬膜外止痛组 (P组 ,n =10 ) ,观察手术结束时、术后 3、6、2 4h病人血糖、血浆皮质醇、胰岛素、胰高血糖素、肾上腺素及去甲肾上腺素的水平。结果　①三种止痛模式 ,都能产生优良的镇痛效果 ;②在抑制高血糖反应方面P组、E组优于M组 ,③P组、E组更能有效地抑制应激激素的分泌 ,④P组止痛效果与E组相似但硬膜外止痛药的用量减少。结论　硬膜外止痛模式可以更有效的降低术后高血糖反应 ,抑制术后应激反应。术前肌注可乐定可减少硬膜外止痛药的用量。更多还原

【Abstract】 Objective To compare the effect of three different analgesic techniques on hyperglycemia and stress response to cholecystotomy so as to select a more reasonable analgesic modelMethods Thirty patients after cholecystotomy ,were randomly divided into three groups using three different analgesic techniques:postoperative intravenous morphine patient-controlled analgesia(PCA)(group M),postopetative epidural PCA(group E),and pre-emptive clonidine combined with postoperative epidurral PCA(group P)Blood glucose,plasma levels of stress hormones such as cotisol,insulin,glucagon,epinephrine and norepinephrine were measured at various timesResults All three analgesic techniques produced satisfactory pain reliefHyperglycemiawas inhibited more efficiently in group E and P than in group MThe secretions of stress hormoneswere less suppressed in group M than in other two groupsThe epidural analgesics requirement in group P was lower than in group E(P<001)Conclusions Epidural analgesic technique can reduce hyperglycemia and stress response after cholecystotomy more efficientlyA pre-emptive clonidine analgesia can reduce required dosage of the the followed epidural analgesics更多还原