摘要
目的:观察胸段硬膜外阻滞对急性心肌梗死(acutemyocardialinfarction,AMI)患者焦虑抑郁状态以及体内去甲肾上腺素NE、肾上腺素、促肾()上腺皮质激素(ACTH、皮质醇等应激激素水平的影响。)方法:选择AMI患者78例,随机分为治疗组(39例)和对照组(39例),治疗组患者选择T3～4或T4～5间隙行硬膜外穿刺,穿刺成功后置入硬膜外导管,接4mL/h微量注射泵持续注入5g/L利多卡因注射液,根据病情缓解情况,持续一两周。对照组常规内科治疗。于阻滞前及阻滞后1,12,24,72h抽取静脉血标本,测定各时段的NE,肾上腺素,ACTH,皮质醇应激激素的含量,并于1周后评定患者的精神状态。结果:阻滞后治疗组患者的NE,肾上腺素,ACTH,皮质醇应激激素的含量与阻滞前及同时段的对照组比较明显降低(t=7.89～12.54,P<0.05)。1周后患者精神状态评分治疗组明显优于对照组(χ2=17.79～19.68,P<0.05)。结论:胸段硬膜外阻滞可快速有效地缓解由于冠状动脉供血不足引起的缺血性疼痛,缓解患者过度焦虑、抑郁及恐惧情绪,抑制应激反应,降低患者体内NE,肾上腺素,ACTH,皮质醇应激激素的水平,有效地扩张冠状动脉,改善心肌的血液供应。有利于患者早期康复。
AIM: To study the effect of thoracic epidural block on anxiety and depression and the levels of norepinephrine noradrenaline(NE),epinephrine,adrenocorticotrophic hormone(ACTH) and hydrocortisone in patients with acute myocardial infarction(AMI).<METHODS: Seventy eight patients with AMI were divided randomly into study group(n=39) and control group (n=39).The patients in the study group had thoracic(T) 3- 4 or 4- 5( T3- 4 or T4- 5) vertebral clearance for puncture and continuously injection of 5 g/L lidocaine into extradural pipe ( 4 mL per hour) with injectoc pum which lasted for one to two weeks based on the recovery.The patients in the control group had medicine therapy.Before and one,twelve,twenty four and seventy two hours after block,venous blood was phlebotomized and the levels of NE,ACTH and cortisol were mensurated.One week later,their psychosis symptoms were evaluated.<RESULTS:The levels of NE,adrenalin,ACTH and cortisol in the study group were obviously decreased compared with before block in the same group and contemporaneous ones in the control group(t=7.89- 12.54, P< 0.05).After one week,psychosis symptoms in the study group were superior to those in the control group(χ 2=17.79- 19.68, P< 0.05) .<CONCLUSION:For the patients with AMI,thoracic epidural block can efficiently lighten the headache induced by deficient blood supply of coronary artery,improve psychosis symptoms such as too much anxiety,depression and dread,inhibit stress reaction,reduce the levels of NE,epinephrine,ACTH and hydrocortisone, expand coronary artery effectively,and improve the blood supply of myocardium so as to make for early rehabilitation.
出处
《中国临床康复》
CSCD
2004年第36期8164-8166,共3页
Chinese Journal of Clinical Rehabilitation
