【摘要】 目的　探讨高位硬膜外不同药物术后镇痛对断指再植病人内分泌及呼吸功能的影响。方法　 10 0例断指再植病人根据用药不同随机分为对照组、吗啡组、芬太尼组、新斯的明组和曲马多组 ,并测定麻醉前、术后 4、8、12和 2 4h皮质醇、血管紧张素Ⅱ、肾上腺素和去甲肾上腺素的血浆浓度 ,同时记录VAS评分、呼吸频率、潮气量、血氧饱和度和PETCO2 的变化及不良反应。结果　镇痛组间内分泌激素的水平相比无明显差异 ,但与对照组相比显著降低。组内与麻醉前相比显著降低。呼吸功能各组无显著性差异。镇痛 4组VAS评分均较低 ,与麻醉前和对照组相比有非常显著性差异 ,M组和F组病人镇痛效果较佳 ,但M组和N组病人尿潴留和心动过缓等不良反应明显。结论　高位硬膜外连续术后镇痛能有效地抑制断指再植病人的应激反应 ,对呼吸功能无明显影响 ,芬太尼因镇痛效果确切、不良反应少而更适用于此类病人更多还原

【Abstract】 Objective To investigate the effects of continuous cervical epidural with different drugs for postoperative analgesia on endocrine and respiratory function in patients after replantation of amputated fingers Methods One hundred patients undergoing emergency replantation of amputated fingers were randomly divided into five groups: control group(C), morphine group(M), fentanyl group(F), neostigmine group(N), and tramadol group(T) The patients in group C received no postoperative epidural analgesia The four analgesia groups received continuous epidural infusion of 0 125% bupivacaine at a rate of 2ml/h In addition to droperidol 3mg, morphine 2mg (group M) or fentanyl 200μg (group F) or neostigmine 2mg (group N) or tramadol 200mg (group T) was added to every 100ml of 0 125% bupivacaine The operation was performed under cervical epidural blockade which was performed at C 7 T 1 BP, HR, ECG, SpO 2 and P ET CO 2 were monitored during operation Blood samples were taken from peripheral vein before analgesia and 4, 8, 12, 24h after operation for determination of cortisol, angiotensin Ⅱ(AⅡ), epinephrine(E) and norepinephrine(NE) concentration Postoperative analgesia was assessed by VAS score BP, HR, SpO 2, respiratory rate(RR), tidal volum (V T), and P ET CO 2 were monitored and recorded after operation Results The age, sex, weight and ASA status were comparable among the five groups The VAS score was significantly lower in four analgesia groups than that in group C VAS score was lower in group M and F than that in group N and T, but the difference was not significant among the four groups There was no significantly difference in SpO 2, RR, V T and P ET CO 2 among the five groups (P>0 05) during the postoperative period The cortisol, AⅡ, E and NE levels were comparable among the five groups before anesthesia, but were significantly lower in analgesia groups during the postoperative period than those in group C There was no significant difference in cortisol, AⅡ, E and NE among the four analgesia groups (P>0 05) Conclusions Cervical epidural for postoperative analgesia can effectively inhibit the stress response in patient after the replantation of amputated fingers but dose not affect respiratory function Fentanyl provides best analgesia with less adverse effects and is suitable for postoperative analgesia in these patients更多还原