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Effect of different methods for postoperative pain management on catecholamine response to abdominal surgery
Author(s): 
Pages: 187-190
Year: Issue:  2
Journal: JOURNAL OF PEKING UNIVERSITY(HEALTH SCIENCES)

Keyword:  镇痛/方法疼痛手术后/药物疗法腹部/外科学儿茶酚类/血液;
Abstract: 目的:观察腹部手术后不同镇痛方法的镇痛效果及对儿茶酚胺的影响.方法:42例选择性开腹手术患者,随机分为5组,罗哌卡因芬太尼(ropivacaine fentanyl, RF)、布比卡因芬太尼(bupivacaine fentanyl, BF)、布比卡因吗啡(bupivacaine morphine, BM)组术中1.2 g*L-1硬膜外复合全麻,术后持续硬膜外镇痛,镇痛药物分别为1.2 g*L-1罗哌卡因+2 mg*L-1芬太尼、1.2 g*L-1布比卡因+2 mg*L-1芬太尼、1.2 g*L-1布比卡因+80 mg*L-1吗啡;EM组术中硬膜外复合全麻,术后持续静脉吗啡0.5 g*L-1镇痛;静脉吗啡(intravenous morphine, M)组术中单纯全麻,术后持续静脉吗啡0.5 g*L-1镇痛.记录镇痛效果,测定麻醉前、术后1 h、术后24 h血浆肾上腺素和去甲肾上腺素水平.结果:各组均可获得有效的镇痛效果.VAS评分BM组、M组显著低于RF组,VRS评分BM组明显高于RF、EM、M组.BM、M、EM组副作用较多,M组恶心发生率最高(5例).术后1 h BM组肾上腺素显著低于BF组,EM组去甲肾上腺素明显低于RF组.术后24 h M组肾上腺素和去甲肾上腺素均高于术前.结论:目前常用的硬膜外或静脉病人自控镇痛方法都有明确的镇痛效果,术中复合硬膜外阻滞或术后硬膜外镇痛可以显著减轻术后应激反应的程度,是更有效的术后镇痛方法.
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