冠心病病人术后硬膜外镇痛心电图和内分泌的变化  

Effects of postoperative epidural analgesia on stress response and electrocardiogram in patients with coronary heart disease

作　　者：陈国忠[1] 孙淑清[1] 任旷[1] 李学[1] 周松花[1] 张锐[1] 

机构地区：[1]吉林军医学院附属医院麻醉科,132013

出　　处：《临床麻醉学杂志》2001年第5期260-261,共2页Journal of Clinical Anesthesiology

摘　　要：目的　观察冠心病病人上腹部手术后硬膜外镇痛 (EA)对皮质醇、胰岛素及心电图的影响。方法　比较术后 2 4小时EA与肌注镇痛 (MI)的镇痛效果 ,观察心电图及血清皮质醇、胰岛素和血糖的变化。结果　 (1)EA镇痛效果优于MI组 (VAS :1 5 6± 0 5 3和 4 2 2± 1 74) (P <0 0 1)。 (2 )术后血清皮质醇、胰岛素和血糖浓度EA病人明显低于MI病人 (P <0 0 5 )。 (3)EA组术后ST段压低导联数和压低值总和趋于减少 ;MI术后 10小时和 2 4小时ST段压低导联数和压低值总和明显高于术前水平 (P <0 0 5 ) ,并高于EA组 (P <0 0 5 )。Objective To compare the effect of postoperative epidural single dose bupivacaine analgesia (EA group) with intramuscular injection (MI group) of pethidine after upper abdominal operation on stress response and electrocardiogram in patients with coronary heart disease.Methods The patients were followed up at 6,10 and 24 h after operation and the degree of pain,the change of ECG,the levels of cortisol,insulin and blood sugar were assessed.Results (1)The efficacy of pain relief in EA group was superior to that in MI group(1 56±0 53 vs 4 22±1 74).(2)The levels of cortisol,insulin and blood sugar in MI group were markedly higher than those in EA group.(3)At postoperative 10 h and 24 h,the leads and degree of ST depression of 12lead ECG in MI group were significantly more than preoperative values and those in EA group.Conclusion Postoperative epidural analgesia can markedly reduce the stress response and improve myocardial ischemia in patients with coronary heart disease undergoing upper abdominal operation.

关 键 词：镇痛 冠状动脉疾病 应激反应 心电图 皮质醇 血糖 

分 类 号：R614[医药卫生—麻醉学]