【摘要】 目的探讨手术后非阿片类药物硬膜外镇痛效果及对TNFα、IL-6、IL-2等细胞因子的影响。方法将50例在双持硬膜外麻醉下行子宫切除术的患者按是否进行硬膜外镇痛分组,肌注镇痛者10例(组),硬膜外镇痛者40例,后者随机分为4组:布比卡因组(组);布比卡因+芬太尼组(组);布比卡因+维拉帕米组(组);布比卡因+芬太尼+维拉帕米组(组)。分别于手术麻醉前、术后即刻、术后6 h检测血TNFα、IL-6及IL-2水平,并采用疼痛视觉模拟评分法观察各组术后镇痛情况。结果硬膜外镇痛组镇痛效果好于肌注镇痛组,且组镇痛药用量少。与麻醉前比较,所有患者术后TNFα及IL-2均升高(P<0.05);术后6 h,TNFα及IL-6硬膜外镇痛组低于肌注镇痛组,但差异无统计学意义。结论硬膜外复合用维拉帕米能减少镇痛药用量,镇痛效果更好。有效的硬膜外镇痛能减少机体不良应激反应。更多还原

【Abstract】 Objective To evaluate the nonopioid analgesic drug effect and influence on serum cytokine and postoperative epidural analgesia.Methods With informed consent,fifty patients underwent the hysterectomy with double catheter epidural anesthesia and were assigned to intramuscular injection analgesia group(group Ⅴ) and epidural analgesia group which was randomized into four groups: Bupivacaine group(group Ⅰ),Bupivacaine +Fentanil group(group Ⅱ),Bupivacaine +Verapamil group(group Ⅲ) and Bupivacaine +Fentanil +Verapamil(group Ⅳ).At the same time,the levels of serum TNFα,IL-6 and IL-2 were detected,and the pain assessment was made(visual analogue scale,VAS).Results The effectiveness of epidural analgesia was better than that of intramuscular injection.Epidural verapamil reduced the analgesic cost.The postoperative levels of TNFα and IL-2 were higher than preanesthesia ones of them(P<0.05).The postoperative levels of TNFα and IL-2 in epidural group were lower than those in intramuscular injection analgesia group at 6 hours after operation(P<0.05).Conclusion Epidural verapamil analgesia can reduce analgesic cost,and the effective epidural analgesia can reduce the postoperative distress.更多还原