硬膜外阻滞麻醉及术后镇痛对结肠切除术后胃肠功能的影响

目的　观察硬膜外阻滞麻醉及术后镇痛对结肠切除术后胃肠功能的影响。方法　 4 2例择期行结肠切除术的结肠癌患者 ,被随机分组到对照组 (接受全麻和静脉吗啡术后镇痛 )和实验组 (接受减量全麻 +硬膜外麻醉以及布比卡因、芬太尼硬膜外术后镇痛 )。所有患者术后都接受早期经口进食和辅助运动 ,记录VAS痛觉评分 ,肠蠕动恢复肛门排气的时间 ,住院时间。结果　静息、咳嗽和日常活动的VAS痛觉评分 ,实验组明显低于对照组。蛋白质和热卡的摄入以及卧床的时间基本相同。术后初次肛门排气和肠蠕动发生的时间实验组早于对照组 (P <0 .0 1)。术后并发症发生率及住院时间两组间无显著差异 (P >0 .0 5 )。结论　硬膜外麻醉及镇痛 ,能较快恢复结肠切除术后肠道功能 ,且镇痛效果比静脉吗啡镇痛更好。但住院时间缩短不明显

The effect of thoracic epidural anesthesia and postoperative analgesia on gastrointestinal function after colectomy

Objective To study the effect of thoracic epidural anesthesia and postoperative analgesia on gastrointestinal function after colectomy. Methods Forty|two patients with colonic cancer scheduled for elective colectomy were randomly assigned to either control group (given general analgesia with intravenous morphine, %n%=21) or experimental group (given epidural analgesia with a mixture of bupivacaine and fentanyl, %n%=21). Postoperative early oral feeding and assisted mobilization were offered to all patients. Pain visual analog scale, passage of flatus and bowel movements and length of hospital stay were recorded.Results 1. Pain visual analog scales at rest, on coughing and on daily mobilization were significantly lower in the experimental group than those in the control group. 2. Intake of proteins and calories and time of bed rest were similar in both groups. Mean time intervals + standard deviation from operation to first flatus passage and first bowel movement occurred earlier in the experimental group, 1.9+0.6 days and 3.1+1.7 days, respectively, compared with those in the control group, 3.6+1.5 days and 4.6+1.6 days, respectively (%P%<0.01). 3. Postoperative complications occurred similarly in these two groups. 4. There was no significant difference in length of hospital stay between the two groups.Conclusion Thoracic epidural anesthesia and postoperative analgesia could enhance recovering gastrointestinal function after colectomy and provide superior quality of analgesia than morphine, however, the length of hospital stay was not shortened.