肾移植术后病人硬膜外自控镇痛对血浆一氧化氮、内皮素水平及其平衡的影响  

The effect of postoperative patients controlled epidural analgesia after kidney transplantation on plasma nitric oxide and endothelin balance

作　　者：张耀中[1] 姚蒿梅[1] 叶虹[1] 付耀文[1] 巴凤海[1] 

机构地区：[1]吉林大学中日联谊医院,吉林长春130033

出　　处：《中国实验诊断学》2007年第2期223-225,共3页Chinese Journal of Laboratory Diagnosis

基　　金：吉林省科技厅资助课题(20030537-1)

摘　　要：目的研究肾移植术后病人硬膜外自控镇痛对血一氧化氮(Nitric Oxide,NO),内皮素(Endothelin,ET)水平及其平衡的影响。方法选择ASAⅢ级在硬膜外麻醉下行肾移植手术后病人40例,随机分为硬膜外自控镇痛(PCEA)组(P组n=20)和对照组(C组n=20),术后根据需要间断肌注盐酸派替啶镇痛。两组病人分别于麻醉前、手术后24 h、48 h和72 h采取外周静脉血,测定血浆NO和ET-1,同时监测MAP、HR和CVP及进行VAS评分。结果P组术后各时点血浆NO、ET-1水平及NO/ET-1比值于麻醉前比较差异无显著,血流动力学稳定,VAS评分均小于3分。C组术后各时点血浆NO水平与麻醉前比较差异无显著,而ET-1均显著增高(P<0.05或P<0.01),NO/ET-1比值则明显降低(P<0.05),并与P组相比差异有显著性(P<0.05或P<0.01),术后244、8 hMAP和HR的升高或增快,VAS评分也均大于5分,与麻醉前和C组比较差异显著(P<0.05或P<0.01)。结论肾移植术后病人硬膜外自控镇痛对血浆NO和ET-1均无明显影响,并保持NO/ET-1比值平衡及血流动力学稳定,有利于移植肾功能的恢复。Objective To study the effect of postoperative patients controlled epidural analgesia after kidney transplantation on plasma nitric oxide and endothelin balance.Methods 40ASAⅢ patients after kidney transplantation in epidural block were randomly divided into PCEA for use Graseby-9300 computator analgesia pump peripheral veneus blood samples were taken before anesthesia and at 24 h,48 h,72 h after operation. The phsma NO,ET-1 levels were determined respectively for use nitrate oxidation reduction and ra- dio-immune methods.Results In Group P there were no significant change at 24 h,48h,72 h after operation. In plasma NO,ET-1 and NO/ET-1 ratio than those before anesthesia, and there were increase significantlhy in phsma ET-1（ P 〈 0.05 或 0.01） ,NO/ET-1 ration decrease significantly（ P 〈 0.05）.But there significant differences compared with rose in Group p（ P 〈 0.05 或 0.01 ）.The urines increased at 72 h after operation in Group P than in Group C. But there were no significant in the statistics. Conclusion There were no significant effect of postoperative patients controlled epidural analgesia after kidney transplantaion on plasma nitric oxide and endothelin,and keep NO/ET-1 ratio balance and in favor of recovery renal fun ction in patients after kidney transplantation.

关 键 词：肾移植 术后 硬膜外 自控镇痛 一氧化氮 内皮素 

分 类 号：R699[医药卫生—泌尿科学]