结肠癌术后自控硬膜外镇痛与静脉镇痛对血小板 - 第三军医大学学报.doc

结肠癌术后硬膜外（静脉）自控镇痛对血小板活化的影响 黄 艰，文欣荣，崔 剑，易 斌，顾建腾，鲁开智 （400038 重庆，第三军医大学西南医院麻醉科） [摘要] 目的 探讨结肠癌术后自控硬膜外镇痛与静脉镇痛对血小板活化的影响。方法 选取结肠癌患者70例，采用随机数字表法分为自控硬膜外镇痛组（PCEA组）和自控静脉镇痛组（PCIA组）各35例。术毕给予镇痛药物，PCEA组：舒芬太尼0.5 μg/mL+左布比卡因4 mg/mL，以3mL/h的速度输注，B组：舒芬太尼1 μg/mL +昂丹司琼8 mg+VitB6 100mg以2.5 m/h的速度输注。术后控制VAS评分≤3分。检测术前30 min、手术开始1 h、术毕30 min及术后4 h、12 h、24 h和48 h (记为T1~T7)血小板α-颗粒膜蛋白-140（granule membrane protein-140，GMP-140）、血浆胰岛素和皮质醇含量和血糖浓度，并进行VAS评分，记录术后各种不良反应的发生情况。结果 PCEA和PCIA组分别有34、32例进入本研究。在T5-7时点PCEA组GMP-140含量均低于PCIA组，差异有统计学意义（P0.01）。两组在不同时点血浆胰岛素、皮质醇和血糖含量结果比较，差异无统计学意义（P＞0.05）。在术后T4-7进行VAS评分显示，PCEA组VAS数值均低于PCIA组，差异亦有统计学意义（P0.01）PCEA组术后恶心呕吐发生率低于PCIA组。两组均未出现呼吸抑制病例。结论 患者自控硬膜外镇痛对结肠癌术后血小板活化的抑制效应优于自控静脉镇痛，其不良反应较少，自控硬膜外镇痛是结肠癌患者术后镇痛的较佳方式。 [关键词] 血小板活化；镇痛；患者控制；结肠癌 [中图法分类号] [文献标志码]A Study on effects of PCEA and PCIA on platelet activation in patients with colonic carcinoma operation Huang Jian, Wen Xinrong, Lu Kaizhi, Yi Bin, Gu Jianteng, Cui Jian (Department of Anesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China) [Abstract] Objective To investigate the effects of patient-controled epidural analgesia (PCEA) and patient-controled intravenous analgesia (PCIA) on platelet activation in patients with colonic carcinoma operation. Methods 70 patients with colonic carcinoma, in accordance with the random number table, were divided into 2 groups: Group PCEA) and Group PCIA) (n=35, repectively). The drugs of Group PCEAincluded sufentanil 0.5μg/mL+ levebupivacaine 4 mg/mL.. Background infusion was 3 mL/h . The drugs of Group PCIA included sufentanil 1μg/mL+ondansetron 8 mg+ vitamin B6 100 mg. Background infusion was 2.5 mL/h . VAS was controlled ≤3 after operation. The concentrations of GMP-140, insulin, cortisol and blood glucose were measured 30 min before operation, 1 h after operation and 30 min, 4 h, 12 h, 24 h, 48 h after end of operation((T1~T7). VAS and adverse reaction were also recorded. Results 34 cases in Group PCEA and 32 cases in Gr