硬膜外自控镇痛对妊高征患者剖宫产术后血浆血栓素和前列环素影响的研究  

Effects of Postoperative Patients Controlled Epidural Analgesia (PCEA) on Plasma Thromboxanes(TXA_2) and Prostacyclin(PGI_2) Levels in Patients with Pregnancy-induced Hypertension

作　　者：史文文[1] 张全意[1] 王颖[1] 阎玉荣[1] 

机构地区：[1]滨州医学院附属医院麻醉科,256603

出　　处：《齐齐哈尔医学院学报》2007年第9期1034-1036,共3页Journal of Qiqihar Medical University

摘　　要：目的观察硬膜外自控镇痛对妊娠高血压综合征患者剖宫产术后血浆中血栓素及前列环素的影响。方法选择符合全国统一妊高征诊断标准的妊高征患者36例(中、重度妊高征各18例),随机分为两组。Ⅰ组术后采用硬膜外术后自控镇痛(PCEA),Ⅱ组术后间断按需肌注哌替啶。两组患者均于术前、术终、术后24h和术后48h分别采血测血栓素B2(TXB2)和6-酮-前列环素1α(6-KETO-PGF1a),同时分别记录术前、术终、术后24h和术后48h的血压和心率。结果与术前相比,两组患者术终、术后24h及术后48h的血浆6-KETO-PGF1a浓度均升高(P<0.05)。各时点两组比较无明显差异(P>0.05)。与术前相比,术后24h及术后48hTXB2均明显降低(P<0.05),Ⅰ组降低明显(P<0.05)。术终,术后24h及48hTXB2/6-KETO-PGF1a值均比术前降低(P<0.05),术后24h及术后48hⅠ组降低明显(P<0.05)。术终、术后24h及术后48h的血压均较术前明显降低(P<0.05),术后24h及术后48hⅠ组的血压低于Ⅱ组(P<0.05)。两组各时间点心率均无明显变化,两组之间亦无差别。结论硬膜外自控镇痛降低妊高征患者剖宫产术后血浆中血栓素的浓度,促进血栓素和前列环素平衡的恢复,有利于血压的恢复。Objective To investigate the effects of postoperative patient controlled epidural analgesia （PCEA） on plasma thromboxanes（TXA2 ） and prostacyclin（PGI2 ） levels in patients with pregnancy-induced hypertension undergoing cesarean section. Methods Thirty-six patients with moderate or critical（serious） pregnancy-induced hypertension were randomly divided into two groups with 18 cases in each. Patients in group Ⅰ received PCEA ,while patients in group Ⅱ received intramuscular pethidine. Blood samples were obtained before operation, at the end of operation, 24h and 48h after operation to determine the level of TXB2, 6-KETO-PGF1a. Systolic blood pressure （SBP）, diastolic blood pressure （DBP） and heart rate （HR） were recorded simultaneously. Results 6-KETO-PGF1a level increased significantly at the end of operation, 24h and 48h after operation in both groups, without significant difference between both groups. TXB2 decreased significantly at 24h and 48h after operation, also significantly decreasing in group Ⅰ were observed compared to group Ⅱ. TXB2/6-KETO-pGF1a ratio decreased at the end of operation, 24h and 48h after operation, the differences between the two groups were significant at 24h and 48h after operation. SBP and DBP decreased significantly at the end of operation; 24h and 48h after operation in both groups, the differences between the two were also significant. There were no significant differences of HR at each time in both groups. Conclusions PCEA can reduce the plasma TXA2 levels in patient with preganancy-induced hypertension undergoing cesarean section, reduce TXA2/PGI2 ratio, and promote the recovery of SBP and DBP.

关 键 词：硬膜外自控镇痛 妊高征 血栓素 前列环素 

分 类 号：R256.1[医药卫生—中医内科学]