小剂量纳洛酮硬膜外应用对胃癌术后芬太尼静脉自控镇痛效果及胃肠功能的影响

目的:探讨小剂量纳洛酮硬膜外应用对胃癌术后芬太尼静脉自控镇痛效果及胃肠功能的影响。方法:选取我院2010年7月-2015年7月收治的110例胃癌患者为研究对象,将所有患者随机分为试验组和对照组各55例,两组患者均行根治性肿瘤切除术,术后采用芬太尼静脉自控镇痛,试验组于术后硬膜外注入小剂量纳洛酮,对照组注入等量的生理盐水,对两组术后不同时间点(4 h、8 h、12 h、24 h)疼痛程度进行评分,对比两组肠鸣音恢复时间、肛门排气时间、肛门排便时间、胃动力恢复时间,镇痛泵药物消耗量及并发症发生率。结果:术后4 h,试验组疼痛评分明显低于对照组(P0.05),术后8 h、12 h两组患者的疼痛评分均有显著上升(P0.05),且试验组患者的疼痛评分均远低于对照组(均P0.05),术后24 h,试验组与术后12 h比较差异无统计学意义(P0.05),对照组术后24 h疼痛评分与术后12 h分相比有显著差异(P0.01);试验组患者肠鸣音恢复时间、肛门排气时间、肛门排便时间、胃动力恢复时间、镇痛泵药物消耗量、芬太尼用量均远远低于对照组(P0.05);试验组并发症总发生率(7.27%)远远低于对照组(23.64%),差异具有统计学意义(P0.05)。结论:采用小剂量纳洛酮硬膜外应用方法辅助术后镇痛可以有效的减轻患者的疼痛,降低并发症的发生率,促进胃肠功能恢复,疗效显著,值得在临床上推广使用。

Effects of Small Dose of Naloxone Epidural Application on FentanylIntravenous Analgesia and Gastrointestinal Function of Patients after Surgeryfor Gastric Cancer

Objective:To explore the effects of small dose of naloxone epidural application on fentanyl intravenous analgesia andgastrointestinal function of patients after surgery for gastric cancer.Methods:110 cases of patients with gastric cancer in our hospitalfrom July 2010 to July 2015 were selected as the research subject, who were randomly devided into experimental group and controlgroup with 55 cases in each. The patients in the two groups were treated with radical resection of tumor and fentanyl intravenous analgesia,and the experimental group were injected with small dose of naloxone into the epidural space, and the control group were injectedwith equal amount of saline.The pain degree of two groups at different time points(4 h, 8 h, 12 h, 24 h)were evaluated. The recovery timeof bowel sound, anal exhaust time,defecation time, recovery time of gastric motility, drug consumption of analgesic pump and the rates ofnausea, complications of patients in the two groups were observed and compared.Results:The pain score in the experimental group postoperative4 h was significantly lower than that in the control group (P<0.05), of which the two groups were significantly increased postoperative8 h and 12 h (P<0.05), but the pain scores in the experimental group were far lower than those of the control group (P<0.05).There was no significant difference in the pain scores of the experimental group postoperative 12 h with that postoperative 24h(P>0.05),of which the control group was significantly different comparing with postoperative 12 h (P<0.05). The recovery time of bowel sound,anal exhaust time, defecation time, recovery time of gastric motility, drug consumption of analgesic pump and dosage of fentanyl in theexperimental group were significantly lower than those in the control group (P<0.05). The total incidence of complications in the experimentalgroup (7.27%)was much lower than that in the control group (23.64%), and the difference was statistically significant(P<0.05).Conclusion:It is effective to reduce the pain of patients, reduce the incidence of complications and promote the recovery of gastrointestinalfunction by small dose of naloxone epidural application, and it is worth to be popularized in clinical practice.