氯诺昔康混合芬太尼对冠心病病人腹部手术后心律失常和血小板功能的影响  

Effects of lornoxicam combining with fentanyl on postoperative arrhythmia and platelet function in patients with coronary artery disease after abdominal surgery

作　　者：王军[1] 胡毅平[1] 丁浩中[2] 黄政坤 顾静雄[4] 

机构地区：[1]江苏省无锡市第一人民医院麻醉科,214002 [2]无锡市第四人民医院麻醉科 [3]江原医院麻醉科 [4]江苏省无锡市第一人民医院中心实验室

出　　处：《中华麻醉学杂志》2005年第4期258-262,共5页Chinese Journal of Anesthesiology

摘　　要：目的研究氯诺昔康混合芬太尼对冠心病病人腹部手术后心律失常和血小板功能表达的影响。方法择期行腹部手术的冠心病病人80例,AsAⅡ或Ⅲ级,年龄51～66岁,随机分为2组, 每组40例。A组术中及术后用芬太尼镇痛,B组术中及术后用氯诺昔康混合芬太尼镇痛,两组术后均给药2 d。两组麻醉诱导及维持用药相同。分别于术后4、12、24、48 h用视觉模拟评分法(VAS)评定疼痛程度。术前1 d～术后8 d连续监测心电图V1、V5和Ⅱ导联、血压及心率变化。分别于术前1 d、术后6 h、术后1、2、7、8 d测定血小板计数(PLT)、凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血酶时间(PTT)及血小板膜糖蛋白C D41/CD61、CD62P、CD63表达。结果两组术后4、12、24、48 h VAS评分比较差异无统计学意义(P>0.05)。与术前1 d比较,两组术日～术后2 d房性早搏及室性早搏发生频率升高,B组术后7-8 d房性早搏发生频率降低(P<0.05或0.01),其余时点差异无统计学意义(P> 0.05);B组术后7～8 d房性早搏发生频率低于A组(P<0.05或0.01)。与术前1 d比较,A组术后6 h ～术后8 d、B组术后6 h～术后7 d血小板膜糖蛋白CD41/CD61及CD63表达均升高,A组术后6 h～术后7 d、B组术后6 h～术后2 d血小板膜CD62p表达升高,B组术后8 d血小板膜糖蛋白CD62p表达降低(P <0.05或0.Objective To investigate the effects of patient-controlled intravenous analgesia (PCIA) with lornoxicam and fentanyl on arrhythmia and the expression of platelet membrane glycoproteins in patients with coronary artery disease (CAD) after abdominal surgery.Methods Eighty ASA II or III patients with CAD aged 51-66 yrs weighing 59-68 kg presenting for bdominal surgery participated in this study. CAD was diagnosed by clinical symptoms and ischemic changes on ECG. The patients were premedicated with intramuscular henobarbital 0.1 g and scopolamine 0.3 mg. Anesthesia was induced with fentanyl, droperidol, propofol and vecuronium and maintained with propofol, fentanyl and vecuronium. The patients received PCIA after operation. The PCIA solution contained fentanyl 0.9 mg and droperidol 5 mg in 100 ml of normal saline (N.S. ) in group A ( n - 40) or lomoxicam 56 mg, fentanyl 0.2 mg and dropendol 5 mg in 100 ml N.S. in group B ( n = 40). In group A the loading dose was fentanyl 0.05 mg and in group B lornoxicam 4 mg. PCIA included a background infusion at 2 ml · h-1 and a bolus of 0.5 ml with a 15 min lock-out. VAS (0 = no pain, 10 = worst pain) was used to measure pain intensity In addition to BP, HR and SpO2 monitoring ECG was continuously monitored with a Holler monitor after operation Blood samples were taken from peripheral vein before and 6h after operation and on the 1st, 2nd, 7th and 8th postoperative days for determination of the expression of CD62p, CD63 and CD41/CD61 on the platelet membrane, platelet count, prothrombin time ( PT) thrombin time (TT) and partial thromboplastin time (PTT) Results The two groups were comparable with respect to sex, age, body weight, severity of CAD, duration of operation and intraoperative blood loss. The patients received no blood transfusion during operation. There was no significant difference in VAS score, platelet count, PT, TT and PIT between the two groups. The incidence of atrial and ventricular premature beat on ECG and the expression of CD41 /CD61 , CD62P and CD63 on the

关 键 词：氯诺昔康 芬太尼 冠心病 腹部手术 心律失常 血小板功能 

分 类 号：R614[医药卫生—麻醉学]