氟比洛芬酯对髓核摘除术患者镇痛及应激反应的影响
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摘要
目的:研究氟比洛芬酯(FA)对髓核摘除术患者镇痛及应激反应的影响;探讨体内FA活性代谢物氟比洛芬(FP)浓度与前列腺素E2(PGE2)浓度的相关性。方法:40例拟行髓核摘除术的椎间盘突出患者,随机分成实验组(FA组,n=20)和对照组(C组,n=20)。FA组麻醉前15min静注FA 1mg·kg-1,术后给予FA 2 mg·kg-1联合芬太尼10μg·kg-1通过镇痛泵静脉给药;C组麻醉前15min静脉给予等容量的乳酸钠林格注射液作安慰剂对照,术后给予芬太尼15μg·kg-1通过镇痛泵静脉给药。于适当时间采集血样测定FP、PGE2与C反应蛋白(CRP)浓度。比较两组患者血浆PGE2和血清CRP水平差异;分析FP浓度与PGE2浓度的相关性;观察并记录患者术中心率、血压等变化,并进行术后3h、6h、15h及24h疼痛程度评分(VAS)和Ramesay镇静评分;观察是否发生恶心、呕吐、头晕、嗜睡、出汗、呼吸抑制等不良反应;相关指标采用SPSS10.0进行统计学分析。结果:手术过程至术后24h PGE2水平,FA组与麻醉前比较无显著性差异(P>0.05);C组均升高(P<0.05),且在术中30min和术毕即刻,C组PGE2水平高于FA组(P<0.05)。CRP水平,两组术后6h和24h均比麻醉前升高(P<0.05),但升高幅度C组大于FA组(P<0.05)。两组VAS评分与Ramesay镇静评分均无显著性差异(P>0.05)。麻醉穿刺时平均动脉压(MAP),FA组低于C组(P<0.01),其余各时点两组之间无显著性差异(P>0.05)。两组患者各时点心率(HR)比较,差异无统计学意义(P>0.05)。两组患者麻醉穿刺时、切皮时、术中30min、术毕即刻各时点MAP和HR,与麻醉前比较均升高(P<0.01),后三时点MAP及HR与穿刺时比较均降低(P<0.01)。不良反应发生率,C组高于FA组(P<0.05)。FP浓度与PGE2浓度无相关性(P>0.05)。结论:FA用于超前镇痛和术后镇痛,可以降低腰椎间盘突出髓核摘除术患者术中及术后PGE2和CRP水平,可以减少术后芬太尼镇痛用量从而减少不良反应。
0bjective
1. To investigate the effect of flurbiprofen axetil(FA) used as preemptive and postoperative analgesic on the plasma level of PGE2 and the serum level of CRP in resection of nucleus pulposus.
2. To investigate the relationship between the plasma concentration of FP which is the active metabolin of flurbiprofen axetil(FA) and the plasma concentration of PGE2.
Methods
40 patients undergoing resection of nucleus pulposus were randomly divided into two groups: group FA (who underwent injection of FA,n=20) and C (control group,n=20). 1mg·kg-1 FA was injected intravenously on each patients for preemptive analgesia 15min before anesthesia . 2 mg·kg-1 FA combined with 10μg·kg-1fentanyl and 20mg azasetron plus sodium lactate Ringer’s injection to 100mL in PCA pump in group FA. while in group C, the same volume of sodium lactate Ringer’s injection was instead of FA 15min before anesthesia and 15μg·kg-1 fentanyl and 20 mg azasetron without FA plus sodium lactate Ringer’s injection to 100mL in PCA pump for postoperative analgesia. Blood was drawn for detecting of FP , PGE2 and CRP. Compare the concentration of plasma PGE2 and serum CRP between the two groups; Analyze the relationship between FP and PGE2; Observe and register MAP and HR during operation and VAS score of pain, Ramesay sedation score on 3h,6h,15h and 24h after operation; Observe the adverse effects such as nausea and vomit .Analyze these indexes by spss 10.0.
Results
To compare with the level 15 min before anesthesia,the level of CRP in group FA significantly increased after operation (P<0.05)and PGE2 had no significant changes during and after operation(P>0.05).While in group C, the level of CRP and PGE2 both signigficantly increased during and after operation(P<0.05).The level of CRP in group C was much higher than that of group FA after operation(P <0.05) and PGE2 in group C was much higher than that of group FA 30min after skin incision and immediately at the end of operation(P<0.05). VAS,Ramesay sedation score both had no significant differences(P>0.05). MAP in FA was significantly lower than that of C (P<0.01)on pricking of anesthesia. HR had no significant differences between the two groups on any time.MAP and HR on pricking of anesthesia, skin incision,30 min after skin incision and immediately after operation was significantly higher than that before anesthesia in both of the two groups;MAP and HR on skin incision, 30 min after skin incision and immediately after operation was significantly lower than that of pricking (P<0.01)in both of the two groups. Adverse effects in group C were much more(P<0.05), too. FP and PGE2 had no relationship .
Conclutions
Flurbiprofen axetil as a preemptive and postoperative analgesic can attenuate the degree of stress reaction in lumar discectomy and reduce the dose of fentanyl and the adverse effects.
0bjective
1. To investigate the effect of flurbiprofen axetil(FA) used as preemptive and postoperative analgesic on the plasma level of PGE2 and the serum level of CRP in resection of nucleus pulposus.
2. To investigate the relationship between the plasma concentration of FP which is the active metabolin of flurbiprofen axetil(FA) and the plasma concentration of PGE2.
Methods
40 patients undergoing resection of nucleus pulposus were randomly divided into two groups: group FA (who underwent injection of FA,n=20) and C (control group,n=20). 1mg·kg-1 FA was injected intravenously on each patients for preemptive analgesia 15min before anesthesia . 2 mg·kg-1 FA combined with 10μg·kg-1fentanyl and 20mg azasetron plus sodium lactate Ringer’s injection to 100mL in PCA pump in group FA. while in group C, the same volume of sodium lactate Ringer’s injection was instead of FA 15min before anesthesia and 15μg·kg-1 fentanyl and 20 mg azasetron without FA plus sodium lactate Ringer’s injection to 100mL in PCA pump for postoperative analgesia. Blood was drawn for detecting of FP , PGE2 and CRP. Compare the concentration of plasma PGE2 and serum CRP between the two groups; Analyze the relationship between FP and PGE2; Observe and register MAP and HR during operation and VAS score of pain, Ramesay sedation score on 3h,6h,15h and 24h after operation; Observe the adverse effects such as nausea and vomit .Analyze these indexes by spss 10.0.
Results
To compare with the level 15 min before anesthesia,the level of CRP in group FA significantly increased after operation (P<0.05)and PGE2 had no significant changes during and after operation(P>0.05).While in group C, the level of CRP and PGE2 both signigficantly increased during and after operation(P<0.05).The level of CRP in group C was much higher than that of group FA after operation(P <0.05) and PGE2 in group C was much higher than that of group FA 30min after skin incision and immediately at the end of operation(P<0.05). VAS,Ramesay sedation score both had no significant differences(P>0.05). MAP in FA was significantly lower than that of C (P<0.01)on pricking of anesthesia. HR had no significant differences between the two groups on any time.MAP and HR on pricking of anesthesia, skin incision,30 min after skin incision and immediately after operation was significantly higher than that before anesthesia in both of the two groups;MAP and HR on skin incision, 30 min after skin incision and immediately after operation was significantly lower than that of pricking (P<0.01)in both of the two groups. Adverse effects in group C were much more(P<0.05), too. FP and PGE2 had no relationship .
Conclutions
Flurbiprofen axetil as a preemptive and postoperative analgesic can attenuate the degree of stress reaction in lumar discectomy and reduce the dose of fentanyl and the adverse effects.
引文
1.徐杰,温发贤,梁吉文.腹腔镜手术对血清TNF. IL-6等水平影响的观察.放射免疫学杂志,2005,18(6):477-478.
2. Segawa H, Mori K, Kasai K, et a1. The role of phrenic nerves in stress response in upper abdominal surgery.Anesth Analg,1996,82(8):1215-1224.
3. Crofter TA, Muller JE, Quittkat D, et a1. Effect of anesthesia on the cytokine responses to abdominal surgery. Br J Anesth, 1994, 72(3):280-285.
4. Ohmukai O. Lipo-NSAID preparation[ J ]. Adv Drug Delivery Reviews,1996,20,203-207.
5. Moote C. Efficacy of nonsteroidal anti-inflammatory drugs in the management of postoperative pain[ J ]. Drugs,1992,44(Suppl 5):14-29.
6. Rao AS,Cardosa M,Inbasegaran K.Morphine-sparing effect of ketoprofen after abdominal surgery.Anaesth Intensive Care,2000,28:22-26.
7. Le Bars D, Adam F. Nociceptors and mediators in acute inflammatory pain[J]. Anin Fr Anesth Reanim, 2002,21(4):315-335.
8. Schwenk W, Jacobi C, Mansmann U, et al. Inflammatory response after laparoscopic and conventional colorectal resections-results of a prospective randomized trial [J].Langenbecks Arch Surg,2000,385(1):2-9.
9. Fornara P,Doehn C,Seyfarth M,et al.Why is urological laparoscopy minimally invasive[J]? Eur Urol,2000,37(3):241-250.
10.柴小青,方才,陈昆洲.术前静脉注射氟比洛芬酯对开胸手术患者围术期血液内啡肽、前列腺素E2和细胞因子水平的影响.中华麻醉学杂志,2007,27(7):603-606.
11. Bennett A ,Stamford IF ,Berstock DA ,et al. Breast cancer: prostaglandins andpatient survival[J] .Br J Cancer,1989 ,59(2) :268-275.
12. Vergote IB , Laekeman GM , Keersmaekers GH , et al. Prostaglandin F2 alpha in benign and maligant breast tumors[J].Br J Cancer, 1985,51(6) :827-836.
13. Honn KV , Bockman RS ,Marnett LJ . Prostaglandins and cancer : a review of tumor intiation through tumor metastasis[J].Prostaglandins,1981,21(5):833-864.
14. Naito Y, Tamai S, Shingu K, et a1.Responses of plasma adrenocorticotropic hormone,cortisol,and cytokines during and after upper abdominal surgery. Anesthesiology,1992,77(3): 426-431.
15. Schulze S. Humoral and neural mediators of the systemic response to Surgery. Dan Med Bull,1993,40(3):365-477.
16. Wortel CH, Deventer SJ, Harden LA, et al. Interleukin-6 mediates host defense responses induced by abdominal surgery. Surgery, 1993,114 (6):564-570.
17. Grapes,Tramer . Do we need preemptive analgesia for the treatment of postoperative pain? Best Pract Res Clin Anaesthesiol.2007,21(1):51-63.
18. Yamashita K,Fukusaki M,Ando Y,et,al.Preoperative administration of intravenous flurbiprofen axetil reduces postoperative pain for spinal fusion surgery. J Anesth, 2006,20(2):92-95.
19. Nakayama M, Ichinose H,Yamamoto S,et al.Perioperative intravenous flurbiprofen reduces postoperative pain after abdominal hysterectomy.Can J Anaesth,2001,48:234-237.
20. Wnek W,Zajaczkowska R,Wordliczek J,et al.Influence of preoperative ketoprofen administration on analgesic requirement and the level of prostaglandins in the early postoperative period.POL J Pharmacol,2004,56(5):- 547-552.
21.辜晓岚,徐建国.塞来昔布超前镇痛在骨科手术的应用.临床麻醉学杂志,2006,22(1):19-21.
22.刘升,谭锦凤,黄立,等.肺癌患者PGE2的测定及其临床意义.江西医药,2006,41(8):639-640.
23.王晖,吴小涛,熊传芝,等.椎间盘镜腰椎间盘切除术与开放式手术对患者应激反应的实验研究.中国矫形外科杂志,2007,15(19):1504-1507.
24. Mahdy AM, Galley HF, Abdel-Wahed MA, et a1. Differential modulation of interleukin-6 and interleukin-10 by diclofenac in patients undergoing major surgery.Br J Anesth,2002,88(6):797-802.
25. Gillies GWA,Kenny GNC,Bullingham RES,et al.The morphine sparing effect of ketorolac tromethamine .Anaesthesia ,1987,42:727-731.
26. Hodsman NBA,Burns J,Blyth A,et al .The morphine sparing effects of diclofenac sodium following abdominal surgery.Anaesthesia, 1987,42:1005-1008.
1.徐杰,温发贤,梁吉文.腹腔镜手术对血清TNF. IL-6等水平影响的观察.放射免疫学杂志,2005,18(6):477-478.
2. Segawa H, Mori K, Kasai K, et a1. The role of phrenic nerves in stress response in upper abdominal surgery.Anesth Analg,1996,82(8):1215-1224.
3. Naito Y, Tamai S, Shingu K, et a1.Responses of plasma adrenocorticotropic hormone,cortisol,and cytokines during and after upper abdominal surgery. Anesthesiology,1992,77(3): 426-431.
4. Schulze S. Humoral and neural mediators of the systemic response to Surgery. Dan Med Bull,1993,40(3):365-477.
5. Wortel CH,Van Deventer SJ, Aarden LA, et al. Interleukin-6 mediates host defense responses induced by abdominal surgery. Surgery,1993,114 (6):564-570.
6. Helmy SA, Wahby MA.EL-Nawaway M. The effect of anesthesia and Surgery on plasma cytokine production.Anesthesia,1999,54(8):733-738.
7. Pittet D, Rangel-Frausto S, Li N, et a1. System inflammatory response syndrome, sever sepsis and septic shock: incidence, mortalities and outcomes in surgical ICU patients. Intensive Care Med. 1995,21(4):302-309.
8. Mahdy AM,Galley HF,Abdel-Wahed MA,et a1.Differential modulation of interleukin-6 and interleukin-10 by diclofenac in patients undergoing major surgery.Br J Anesth,2002,88(6):797-802.
9. Kato M, Suzuki H,Handa I , et a1.Interleukin-10 production during and after upper abdominal surgery. J Anesth,1998,10(3):184-188.
10.钱燕宁,林桂芳.上腹部手术病人围术期胰岛素敏感性的改变.临床麻醉学杂志,1998,14(5):277-279.
11. Heinrich PC, Castell JV, Andus T. Interleukin-6 and the acutephase response. Biochem J, 1990,265(3):621-636.
12. Woiciechowsky C,Schoning B,Wolfgang R,et al.Mechanisms of brain-mediated systemic anti-inflammatory syndrome causing immunodepression. J Mol Med ,2000,77(11):769-80
13.刘瑶,郭曲练,鄢建勤.联合腰麻硬膜外麻醉在脐以下手术中的应用.中国现代医学杂志,2001,11(10):42-43
14. Crofter TA, Muller JE, Quittkat D, et a1. Effect of anesthesia on the cytokine responses to abdominal surgery. Br J Anesth, 1994, 72(3):280-285.
15. Roy S, Cain KJ, Chapin RB, et a1. Morphine modulates NF kappa B activation in macrophages. Biochem Biophys Res Commun,1998,245(2):392-396.
16. Block BM, Liu SS, Rowlingson AJ. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA, 2003,290(18):2455-2463.
17. Viscusi ER. Emerging techniques in the management of acute pain: epidural analgesia. Anesth Analg, 2005,10l(5 Supp1):S23-29.
18.吴越宏.静脉和硬膜外镇痛对老年患者术后镇痛效果及应激反应的影响.国际医药卫生导报. 2007,13(13):16-19.
19. Taqi A, Hong X, Mistraletti G, et al. Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program. Surg Endosc. 2007,21(2):247-52.
20. Weissman C. The metabolic response to stress: an overview and update. Anesthesiology, 1990,73(2):308-327.
21. Yokoyama M, Itano Y, Katayama H, et a1. The effects of continuous epiduralanesthesia and analgesia on stress response and immune function in patients undergoing radical esophagectomy. Anesth Analg, 2005,101(5):1521-1527.
22. Volk T, Schenk M, Voigt K, et a1. Postoperative epidural anesthesia preserves lymphocyte, but not monocyte, immune function after major spine surgery. Anesth Analg,2004,98(4):1086-1092.
23. Salerno A, Hermann R. Efficacy and safety of steroid use for postoperative pain relief. Update and review of the medical literature. J Bone Joint Surg Am. 2006,88(6):1361-1372.
24. Beaussier M, El'Ayoubi H, Schiffer E,et al. Continuous preperitoneal infusion of ropivacaine provides effective analgesia and accelerates recovery after colorectal surgery: a randomized, double-blind, placebo-controlled study.Anesthesiology,2007,107(3):461-8.
25. Kawasaki C, Kawasaki T, Ogata M, et a1. Ketamine isomers suppress superantigen-induced proinflammatory cytokine production in human whole blood. Can J Anesth,2001, 48(8):819-823.
26. Kissin 1, Bright CA, Bradley EL. The effect of ketamine on opioid-induced acute tolerance: can it explain reduction of opioid consumption with ketamine-opioid analgesic combinations.Anesth Ant, 2000,91(6):1483-1488.
27. Chilvers CR, Nguyen MH, Robertson IK.Changing from epidural to multimodal analgesia for colorectal laparotomy: an audit. Anesth Intensive Care. 2007,35(2):230-8.
28. Adams HA, Saatweber P, Schmitz CS, et a1. Postoperative pain management in orthopaedic patients: no differences in pain score, but improved stress control by epidural anesthesia. Eur J Anesthesia, 2002,19(9):658-665.
29. Yamashita K,Fukusaki M,Ando Y,et,al.Preoperative administration of intravenous flurbiprofen axetil reduces postoperative pain for spinal fusion surgery. J Anesth, 2006,20(2):92-95.
2. Segawa H, Mori K, Kasai K, et a1. The role of phrenic nerves in stress response in upper abdominal surgery.Anesth Analg,1996,82(8):1215-1224.
3. Crofter TA, Muller JE, Quittkat D, et a1. Effect of anesthesia on the cytokine responses to abdominal surgery. Br J Anesth, 1994, 72(3):280-285.
4. Ohmukai O. Lipo-NSAID preparation[ J ]. Adv Drug Delivery Reviews,1996,20,203-207.
5. Moote C. Efficacy of nonsteroidal anti-inflammatory drugs in the management of postoperative pain[ J ]. Drugs,1992,44(Suppl 5):14-29.
6. Rao AS,Cardosa M,Inbasegaran K.Morphine-sparing effect of ketoprofen after abdominal surgery.Anaesth Intensive Care,2000,28:22-26.
7. Le Bars D, Adam F. Nociceptors and mediators in acute inflammatory pain[J]. Anin Fr Anesth Reanim, 2002,21(4):315-335.
8. Schwenk W, Jacobi C, Mansmann U, et al. Inflammatory response after laparoscopic and conventional colorectal resections-results of a prospective randomized trial [J].Langenbecks Arch Surg,2000,385(1):2-9.
9. Fornara P,Doehn C,Seyfarth M,et al.Why is urological laparoscopy minimally invasive[J]? Eur Urol,2000,37(3):241-250.
10.柴小青,方才,陈昆洲.术前静脉注射氟比洛芬酯对开胸手术患者围术期血液内啡肽、前列腺素E2和细胞因子水平的影响.中华麻醉学杂志,2007,27(7):603-606.
11. Bennett A ,Stamford IF ,Berstock DA ,et al. Breast cancer: prostaglandins andpatient survival[J] .Br J Cancer,1989 ,59(2) :268-275.
12. Vergote IB , Laekeman GM , Keersmaekers GH , et al. Prostaglandin F2 alpha in benign and maligant breast tumors[J].Br J Cancer, 1985,51(6) :827-836.
13. Honn KV , Bockman RS ,Marnett LJ . Prostaglandins and cancer : a review of tumor intiation through tumor metastasis[J].Prostaglandins,1981,21(5):833-864.
14. Naito Y, Tamai S, Shingu K, et a1.Responses of plasma adrenocorticotropic hormone,cortisol,and cytokines during and after upper abdominal surgery. Anesthesiology,1992,77(3): 426-431.
15. Schulze S. Humoral and neural mediators of the systemic response to Surgery. Dan Med Bull,1993,40(3):365-477.
16. Wortel CH, Deventer SJ, Harden LA, et al. Interleukin-6 mediates host defense responses induced by abdominal surgery. Surgery, 1993,114 (6):564-570.
17. Grapes,Tramer . Do we need preemptive analgesia for the treatment of postoperative pain? Best Pract Res Clin Anaesthesiol.2007,21(1):51-63.
18. Yamashita K,Fukusaki M,Ando Y,et,al.Preoperative administration of intravenous flurbiprofen axetil reduces postoperative pain for spinal fusion surgery. J Anesth, 2006,20(2):92-95.
19. Nakayama M, Ichinose H,Yamamoto S,et al.Perioperative intravenous flurbiprofen reduces postoperative pain after abdominal hysterectomy.Can J Anaesth,2001,48:234-237.
20. Wnek W,Zajaczkowska R,Wordliczek J,et al.Influence of preoperative ketoprofen administration on analgesic requirement and the level of prostaglandins in the early postoperative period.POL J Pharmacol,2004,56(5):- 547-552.
21.辜晓岚,徐建国.塞来昔布超前镇痛在骨科手术的应用.临床麻醉学杂志,2006,22(1):19-21.
22.刘升,谭锦凤,黄立,等.肺癌患者PGE2的测定及其临床意义.江西医药,2006,41(8):639-640.
23.王晖,吴小涛,熊传芝,等.椎间盘镜腰椎间盘切除术与开放式手术对患者应激反应的实验研究.中国矫形外科杂志,2007,15(19):1504-1507.
24. Mahdy AM, Galley HF, Abdel-Wahed MA, et a1. Differential modulation of interleukin-6 and interleukin-10 by diclofenac in patients undergoing major surgery.Br J Anesth,2002,88(6):797-802.
25. Gillies GWA,Kenny GNC,Bullingham RES,et al.The morphine sparing effect of ketorolac tromethamine .Anaesthesia ,1987,42:727-731.
26. Hodsman NBA,Burns J,Blyth A,et al .The morphine sparing effects of diclofenac sodium following abdominal surgery.Anaesthesia, 1987,42:1005-1008.
1.徐杰,温发贤,梁吉文.腹腔镜手术对血清TNF. IL-6等水平影响的观察.放射免疫学杂志,2005,18(6):477-478.
2. Segawa H, Mori K, Kasai K, et a1. The role of phrenic nerves in stress response in upper abdominal surgery.Anesth Analg,1996,82(8):1215-1224.
3. Naito Y, Tamai S, Shingu K, et a1.Responses of plasma adrenocorticotropic hormone,cortisol,and cytokines during and after upper abdominal surgery. Anesthesiology,1992,77(3): 426-431.
4. Schulze S. Humoral and neural mediators of the systemic response to Surgery. Dan Med Bull,1993,40(3):365-477.
5. Wortel CH,Van Deventer SJ, Aarden LA, et al. Interleukin-6 mediates host defense responses induced by abdominal surgery. Surgery,1993,114 (6):564-570.
6. Helmy SA, Wahby MA.EL-Nawaway M. The effect of anesthesia and Surgery on plasma cytokine production.Anesthesia,1999,54(8):733-738.
7. Pittet D, Rangel-Frausto S, Li N, et a1. System inflammatory response syndrome, sever sepsis and septic shock: incidence, mortalities and outcomes in surgical ICU patients. Intensive Care Med. 1995,21(4):302-309.
8. Mahdy AM,Galley HF,Abdel-Wahed MA,et a1.Differential modulation of interleukin-6 and interleukin-10 by diclofenac in patients undergoing major surgery.Br J Anesth,2002,88(6):797-802.
9. Kato M, Suzuki H,Handa I , et a1.Interleukin-10 production during and after upper abdominal surgery. J Anesth,1998,10(3):184-188.
10.钱燕宁,林桂芳.上腹部手术病人围术期胰岛素敏感性的改变.临床麻醉学杂志,1998,14(5):277-279.
11. Heinrich PC, Castell JV, Andus T. Interleukin-6 and the acutephase response. Biochem J, 1990,265(3):621-636.
12. Woiciechowsky C,Schoning B,Wolfgang R,et al.Mechanisms of brain-mediated systemic anti-inflammatory syndrome causing immunodepression. J Mol Med ,2000,77(11):769-80
13.刘瑶,郭曲练,鄢建勤.联合腰麻硬膜外麻醉在脐以下手术中的应用.中国现代医学杂志,2001,11(10):42-43
14. Crofter TA, Muller JE, Quittkat D, et a1. Effect of anesthesia on the cytokine responses to abdominal surgery. Br J Anesth, 1994, 72(3):280-285.
15. Roy S, Cain KJ, Chapin RB, et a1. Morphine modulates NF kappa B activation in macrophages. Biochem Biophys Res Commun,1998,245(2):392-396.
16. Block BM, Liu SS, Rowlingson AJ. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA, 2003,290(18):2455-2463.
17. Viscusi ER. Emerging techniques in the management of acute pain: epidural analgesia. Anesth Analg, 2005,10l(5 Supp1):S23-29.
18.吴越宏.静脉和硬膜外镇痛对老年患者术后镇痛效果及应激反应的影响.国际医药卫生导报. 2007,13(13):16-19.
19. Taqi A, Hong X, Mistraletti G, et al. Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program. Surg Endosc. 2007,21(2):247-52.
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