患者自控硬膜外布比卡因和吗啡镇痛对术后肠功能恢复的影响

目的　观察不同的术后镇痛方法对术后肠功能恢复的影响。方法　根据术后镇痛方式的不同将10 0例胃肠手术患者随机平均分为 4组 :传统哌替啶肌注组 (IM组 )作为对照组 ;另外 3组采用自控硬膜外镇痛法 ,B组用药为布比卡因 ;M组为吗啡 ;BM组为布比卡因复合吗啡。记录各组患者的术后镇痛效果、肠鸣音恢复情况、肛门排气时间、恶心、呕吐等。结果　M和BM组镇痛效果明显优于IM或B组 (P <0 0 1) ;B组布比卡因用量显著多于BM组 (P <0 0 1) ,术后肠鸣音恢复、肛门排气明显早于其他 3组 (P <0 0 1) ;与传统肌注哌替啶镇痛IM组比较 ,M和BM组患者术后肠鸣音恢复、排气时间基本相同 (P >0 0 5 )。结论　患者自控硬膜外吗啡或混合低浓度布比卡因用于胃肠手术后镇痛效果良好 ;与传统的肌注镇痛比较 ,对术后肠功能恢复无明显影响 ;自控硬膜外单纯低浓度布比卡因镇痛有促进术后肠功能恢复的效应 ,但术后镇痛效果较差。

The effects of patient controlled epidural analgesis with morphine and bupivacaine on recovery of intestinal function after surgery

Objective To investigate the effect of patient controlled epidural analgesia (PCEA) using morphine and bupivacaine on recovery of intestinal function after surgery. Methods One hundred adult patients undergoing gastrointestinal operation were randomly assigned to four equal groups. IM group received on demand pethidine 1 2mg/kg intramuscularly; B group received bupivacaine by PCEA. M group received morphine by PCEA. BM group received bupivacaine and morphine by PCEA. All pain scores, intestinal function recovery, nausea and vomiting were observed or recorded. Results Pain score were lower in M and BM group than that in IM or B group (P<0 01). Significanthy more bupivacaine was used in B group than that in BM group (P<0 01). Intestinal function recovery was found earliest in B group among the four groups (P<0 01), no significant difference of intestinal function recovery was found among other three groups (P>0 05). Conclusions The PCEA with morphine or mixing of lower bupivacaine concentration for pain relief after gastrointestinal surgery is safe and efficient and there was no difference in recovery of intestinal function, as compared with pethidine intramuscularly. The PCEA with lower bupivacaine concentration can improve recovery of intestinal function after surgery, but it is poor for pain relief.