不同镇痛方法对冠心病病人术后血流动力学及S-T段影响  

Effect of different methods of analgesia on hemodynamics and S-T segment in postoperative patients with coronary artery disease

作　　者：张瑞敏[1] 白九评[1] 吴云霞[1] 陆爱英[1] 李燕[1] 

机构地区：[1]河北医科大学第二医院麻醉科ICU,河北石家庄050000

出　　处：《护士进修杂志》2004年第10期874-876,共3页Journal of Nurses Training

摘　　要：目的观察胸段硬膜外阻滞 (TEA)镇痛与静脉镇痛 (GA)对胸部、上腹部手术的冠心病病人术后血流动力学及S -T段影响 ,为术后监护提供理论依据。方法选择胸部、上腹部手术的冠心病病人 6 0例 ,随机分为TEA组(n =30 )和GA组 (n =30 ) ;TEA组术后采用TEA持续镇痛 ;GA组术后采用静脉持续镇痛 ;记录两组病人手术前一天、术后 4 8h无创血压 (BP)、心率 (HR)、动态ECG变化 ;同时 ,通过动态心电图监测仪监测S -T段变化 ,分析心肌缺血发生例数 ;术日及术后第一天对病人的疼痛情况进行评分 ,采用VAS(视觉模拟 )评分法。结果TEA组房性、室性心律失常较术前一天明显减少 (P <0 .0 1) ,GA组房性、室性心律失常较术前一天明显增加 (P <0 .0 5 ) ,与TEA组比较差异有显著意义 (P <0 .0 1) ;术前 2 4h两组病人S -T段均未见动态变化 ,术后S -T段动态变化 (新抬高 0 .2mv或新压低 0 .0 5mv以上 )TEA组 6例 (31.5 % ) ,GA组 13例 (76 .5 % ) (P <0 .0 5 ) ;TEA组术后血压、心率较GA组平稳 ;TEA组VAS评分 3分以下 19例 ,占 6 3.3% ,GA组 11例 ,占 36 .6 % (P <0 .0 5 ) ;结论胸部、上腹部手术的冠心病病人术后行TEA镇痛血流动力学稳定 ,心肌缺血发生率较GA组低 ;对于术后行GA镇痛的病人更需要加强心脏功能监测。Objective To observe the effect of thoracic epidural anesthesia analgesia and general anesthesia analgesia on hemodynamics and S-T segment in postoperative patients with coronary artery disease undergoing thoracic or upper abdomen surgery, and to provide theoretical evidence for post-operative care. Methods Sixty patients with coronary artery disease undergoing thoracic or upper abdomen surgery were randomly divided into two groups: group of TEA (group-TEA, n=30) and group of general anesthesia (group GA, n=30). Post operation continual epidural analgesia was used for group TEA, and for group GA continual intravenous analgesia was used. ECG trends, non-invasive blood pressure and heart rate the day before operation and 48 hours after operation in two groups were all recorded. And the changes of S-T segment were monitored by Holter monitoring electrocardiogram. The incidence of myocardial ischemia was analyzed. Pain was scored with visual simulate score on the operative day and the first day after operation Results The incidence of atrial or ventricular arrhythmia in group TEA reduced more but in group GA increased more than that the day before operation. There was significant difference between the two groups. There was no S-T development of ECG in two groups 24 hours before operations. There were 6 patients whose S-T segment developed in group TEA, but in group GA there were 13 patients (P<0.05) post operation. Blood pressure and heart rate in group TEA were more stable than that in the other group. There were 19 patients (63.3percent) in group TEA scored under 3 and 11 patients in group GA (36.6 percent) (P<0.05). Conclusions The hemodynamic of the patients who had continual epidural analgesia with coronary artery disease undergoing thoracic or upper-abdomen surgery was more stable, and the incidence of myocardial ischemia was lower than that in group GA. So postoperative patients who had intravenous analgesia need more. Monitoring of myocardial function.

关 键 词：术后 病人 冠心病 血流动力学 上腹部手术 胸部 术前 差异 意义 情况 

分 类 号：R541[医药卫生—心血管疾病] R614[医药卫生—内科学]