冠心病患者胸部手术后硬膜外自控镇痛防治心肌缺血效果观察  

Effect of patient controlled epidural analgesia for preventint cardial myoischemia in patients with coronary heart disease after thoracic surgery

作　　者：胡双飞[1] 钱军[1] 严蔚[1] 

机构地区：[1]浙江省人民医院麻醉科,杭州310014

出　　处：《浙江医学》2006年第5期331-333,共3页Zhejiang Medical Journal

摘　　要：目的观察冠心病患者胸部手术后硬膜外自控镇痛(PCEA)防治心肌缺血的效果。方法对13例行食管癌或肺癌根治术的患者术后予PCEA,观察其围术期血流动力学指标、血清肌钙蛋白(cTnⅠ)和心电图的变化,以视觉模拟评分法评估镇痛效果,并与肌注哌替啶镇痛(MI)者进行比较。结果PCEA组镇痛效果明显优于MI组(P<0.01);血流动力学指标比MI组更平稳(P<0.05);血清cTn1水平明显低于MI组(P<0.05);术后10和24hST段压低导联数和ST段压低值总和趋于减少,且较MI组明显减少(P<0.05)。结论冠心病患者胸部手术后PCEA镇痛效果明显,对防治心肌缺血性损伤有确切的效果。Objective To observe the effect of postoperative epidural analgesia for preventint cardial myoischemia in patients with coronary heart disease undergoing thoracic surgery. Methods Thirteen patients undergoing thoracic surgery were assigned to patient controlled epidural analgesia（PCEA）. The analgesia efficacy, the hemodynamics and serum troponin, ECG changes of PCEA were compared with those with intramuscular injection of pethidine（MI）. Results The analgesia effect of PCEA group was superior to that of MI group（P〈0.01）. The hemodynamics in PCEA group was more stable than that in MI group. The serum troponin concentration of PCEA group was lower than that of MI group （P〈0.05）. The number of cardiac leads with ST-segment depression and the total number of ST-segment depression at 10h and 24h after operation were decreased in PCEA group, but were significantly increased in MI group （P〈0.05）. Conclusion The analgesic effect of PCEA is superior to that of MI; and postoperative PCEA may reduce myocardial ischemia in patients with coronary heart disease undergoing thoracotomy.

关 键 词：病人自控镇痛 胸部硬膜外阻滞 冠心病 心肌缺血 

分 类 号：R614[医药卫生—麻醉学]