摘要
目的:观察腹腔镜胆囊切除术(LC)患者腹腔内应用局麻药的镇痛效果及它对血糖、皮质醇、胰岛素水平的影响。方法:将60例LC患者随机分成3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 h视觉模拟评分(VAS);于诱导前,拔管前,术后6、24、72 h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 h 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 h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 hⅠ组皮质醇浓度较低,差异有统计学意义(P<0.01);术后24 h高于Ⅲ组。术后24、72 hⅠ、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、24、72 h血糖值组间无显著差异(P>0.05)。Ⅰ组术后6 h胰岛素浓度低于其它两组,有显著性差异(P<0.01),术后24 hⅢ组胰岛素低于Ⅰ、Ⅱ组,术后72 hⅠ、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,此方法可减少LC手术的应激反应。
Objective： 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 （ASA I - Ⅱ ） underging elective LC were randomly divided into three groups with 20 peoples in each group. The patinets received analgesia with ropivacaine into intraperitoneal space before surgery （ group I ） or at the end of operation （ group m ）. Group Ⅱwas given 0.9% NaC1. Pain degree was measured using visual analog scale （VAS） at 6 h, 24 h and 48 h after operation in three groups. Plasma cortisol, blood glucose and insuline concentrations were measured before anesthesia and extubaion, at 6 h, 24 h and 72 h after ooeration in three groups. Results： The postoperative pain： the VAS values in group I and m were much lowerthan that in group Ⅱ（P 〈 0.01 ）, and the values in group Ⅲ were lower than that in group Ⅰ The plasma levels of cortisol, blood glucose and insuline were significantly increased after the prodedure compared with those before in all three groups（P 〈0.01 ）. It declined to preoperative level on the postoperative 3rd day in I and m （P 〉0.05）, but was still higer than the baseline level in groupⅡ （P 〈 0.01 ）. The plasma levels of cortisol were declined at 6 h after operation in group I compared with those in group Ⅱand m （P 〈 0.05）. The plasma levels of cortisol was lower at 6 h after operation in group I than that in group Ⅲ, but was higher at 24 h after operation in group I than those in group Ⅲ. The blood glucose of I and Ⅱ had no significant difference at the 24, 72 h after operation （ P 〉 0.05 ）. The plasma levels of glucose in group Ⅱ were much higher at 24 h and 72 h after operation than that in group m （ P 〈 o. Ol ）. The blood glucose of I and m had no significant difference at the 6, 24, 72 h after operation （ P 〉 0.05 ）. The plasma levels of insuline were declined at 6 h after operation in group I compared with those in groupⅡ and m （P 〈 0.05 ）. The plasma levels of insuline in group IU were much lower at 24 h after operation than that in group I and II. The plasma levels of insuline of I and Ⅲ had no significant difference （ P 〉 0.05） at the 72 h after operation （ P 〉 0.05 ）. Conclusions ： Postoperative pain, requirement of pain- killer and stress response after LC can be significantly reduced by intraperitoneal local anesthetic.
出处
《现代医学》
2012年第1期1-4,共4页
Modern Medical Journal
基金
江苏省卫生厅医学新技术引进项目
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
laparoscopic cholecystectomy
ropivacaine
postoperative analgesia
intraperitoneal local anesthetic
stress reaction
