摘要
目的：探讨多模式术后镇痛对心脏病人行非心脏手术围术期心肌保护及其作用机制。方法：合并高血压、缺血心脏病病人择期行胃、胆道手术60例。均施行静吸复合全麻。麻醉诱导：咪达唑仑2~3mg、芬太尼2ug/kg、异丙酚2mg/kg、维库溴铵0.1mg/kg。根据术后镇痛方式不同,随机分为静脉自控镇痛（PCIA）I组（n=20）,硬膜外自控镇痛（PCEA）E组（n=20）,该组病人实施全麻前行胸取9、10椎体间隙硬膜外穿刺置管。成功后,硬膜外腔注入2%利多卡因5mL证实硬膜外阻滞效果,以及未作预镇痛处理组N组（n=20）。I组和E组术毕依据不同镇痛方法注入各自镇痛液5mL,接上镇痛装置,待病人清醒拔管后送返病房。分别于进入手术室（T0）、术毕即刻（T1）、术后24h（T2）、术后48h（T3）,取外周血测定肌钙蛋白I（cTnI）及皮质醇浓度（Cort）,并对镇痛效果行视觉模拟评分（VAS）,观察不良反应。结果：一般资料、手术时间、麻醉苏醒及拔管时间组间比较差异无统计学意义。肌钙蛋白I、皮质醇浓度组间比较（T2、T3）N组较I、E两组有差异意义,组内比较（T2）I、N两组较（T0）有差异有统计学意义。VASN组与I、E两组均表示镇痛良好。不良反应E组较I、N两组少。结论：硬膜外术后镇痛对围手术期心脏病人非心脏手术心肌有良好的保护,可能与适度抑制交感神经活性有关。
OBJECTIVE：To investigate the multi-modal postoperative analgesia on heart disease for noncardiac surgery perioperative myocardial protection and its mechanisms.METHOD：Perform operation on 60 patients of stomach and biliarg tract,conbined intravenous and inhaled anesthesia,and the post operative analgesia were divided into two groups,which were PCIA group and PCEA group.RESULTS： The results of general information,operative time,recovery from anesthesia and extubation time between the two groups showed no significant difference.Troponin I,cortisol levels between the two groups（T2,T3） N group than in I,E 2 group differences in meaning,within the comparison group（T2） I,N 2 group than in（T0） there are differences in meaning.（VAS） N group and I,E 2 group indicated a good analgesic.Adverse reactions E group than in I,N 2 group of less.CONCLUSION：postoperative epidural analgesia on perioperative cardiac non-cardiac surgery have a good myocardial protection may be related to a moderate inhibitory sympathetic activity.
出处
《九江学院学报（自然科学版）》
CAS
2010年第4期71-74,共4页
Journal of Jiujiang University：Natural Science Edition
关键词
术后镇痛
心脏病人
心肌保护
肌钙蛋白I
皮质醇
postoperative analgesia
heart disease
myocardial protection
troponin I
cortisol
blurred vision score
