曲马多复合芬太尼术后镇痛对高血压病患者应激反应的影响  

EFFECTS OF PCIA WITH TRAMADOL PLUS FENTANYL ON STRESS RESPONSES IN PATIENTS WITH HYPERTENSION

作　　者：周述芝[1] 苏锡之[1] 甘西伦[2] 任长和[1] 

机构地区：[1]泸州医学院附属医院麻醉科,泸州646000 [2]泸州医学院附属医院核医学科,泸州646000

出　　处：《中国疼痛医学杂志》2006年第6期341-343,共3页Chinese Journal of Pain Medicine

基　　金：四川泸州医学院课题(0334)

摘　　要：目的:探讨曲马多复合芬太尼静脉自控镇痛对高血压病患者内皮素(ET),肾素-血管紧张素-醛固酮系统(RAAS)的影响。方法:40例拟行骨科手术的高血压病患者随机分为两组:A组为对照组,术后根据需要间断肌注哌替啶镇痛;B组术后行曲马多复合芬太尼静脉自控镇痛(PCIA)。采用放免法测定术前、术毕、术后24 h及术后48 h血浆ET、肾素活性(PRA)及血管紧张素Ⅱ(AngⅡ)浓度;监测心率、血压及VAS评分。结果:B组术毕、术后24 h及48 h血浆ET值显著低于A组(P<0.01),而且B组术毕及术后24 h血浆PRA,AngⅡ值低于A组,B组术后收缩压(SBP)及VAS评分显著低于A组同期值(P<0.01)。结论:术后曲马多复合芬太尼静脉自控镇痛,能有效减轻病人疼痛,抑制高血压患者ET、PRA和Ang II释放和应激反应,维持血液动力学稳定。Objective： To observe the effects of patient controlled intravenous analgesia （PCIA） with tramadol and fentanyl on levels of plasma endothelin（ET）, plasma renin activity（PRA） and angiotensin Ⅱ （Ang Ⅱ ） in patients with hypertension. Methods： Forty cases with hypertension undergoing orthopaedic operation were randomly divided into 2 groups：group A, served as control, pethidine 50 mg im intermittently after operation according to requirement; group B, PCIA with tramadol and fentaryl was carried out after operation. The plasma levels of ET, PRA and Ang Ⅱ before operation, at the end of operation,24 h and 48 h after operation were estimated by radi y. Heart rate （HR） and blood pressure （BP） were monitored and VAS was assessed. Results： The plasma levels of ET at the end of operation, 24 h and 48 h after operation in group B were significantly lower than those in group A（P 〈0.01 ）. PRA and Ang Ⅱ at the end of operation and 24 h after operation in group B were significantly lower than those in group A. VAS and systolic BP（SBP） after operation in group B obviously decreased as compared with those of the same period in group A （P 〈0.01 ）. Conclusion： PCIA with tramadol plus fentanyl can effectively reduce the pain. PCIA can inhibit the release of ET, PRA and Ang Ⅱ , suppress stress responses in patients with hypertension and stabilize the hemodynamic parameters.

关 键 词：高血压 静脉自控镇痛 内皮素 肾素 血管紧张素Ⅱ 

分 类 号：R614[医药卫生—麻醉学] R544.1[医药卫生—外科学]