术后镇痛对冠心病患者围术期心肌损伤的影响  

Effects of Postoperative Different Analgesia Styles on Perioperative Myocardial Injury in Coronary Heart Disease Patients Undergoing Thoracic Surgery

作　　者：严丽萍[1] 吴明慧[1] 陈丽[1] 王莹[1] 

机构地区：[1]湖北省孝感市中心医院麻醉科,432000

出　　处：《中华全科医学》2011年第6期883-884,共2页Chinese Journal of General Practice

摘　　要：目的比较不同镇痛方法对胸科冠心病患者围术期心肌损伤的影响,为胸科冠心病患者选择适宜的术后镇痛方式。方法择期行胸科手术的冠心病患者40例,ASAⅡ～Ⅲ级,随机分为静脉自控镇痛组（PICA组）,硬膜外自控镇痛组（PECA组）,每组20例。两组患者均在全麻复合硬膜外阻滞下手术,术毕分别接PICA和PECA。观察两组患者在围术期血清肌钙蛋白Ⅰ（cTnI）浓度及心电图ST段变化,用视觉模拟评估法评估镇痛效果（VSA评分）。结果两组患者术毕血浆cTnI浓度PECA组比PICA组的浓度明显降低（P〈0.05）。术后各时点心电图ST段改变导联数（NST）和ST段压低幅度的总和（∑ST）PECA组明显比PICA组减少（P〈0.05）。结论胸科冠心病患者术后使用PECA镇痛对防治心肌受损有一定的保护作用。Objective To compare the effects of postoperative different analgesia on the myocardial injury in coronary heart disease patients undergoing thoracic surgery,and to offer a theoretical foundation for better analgesia.Methods Fouty patients,ASA Ⅱ-Ⅲ,undergoing thoracic surgery under general anesthesia combined with epidural block were randomly allocated to patient-controlled intravenous analgesia（PCIA） group（n=20） and patient-controlled epidural analgesia（PCEA） group（n=20）.Blood samples were prepared for the measurement of cTnI.The ST segment changes were recorded.The analgesia effect was assessed using visual analog scores（VAS）.Results The values of cTnI in PECA group were significant lower than those in group PICA（P0.05）.The total leads of depression of ST segment（NST） and sum of depression of ST segment（∑ST） in PECA group were fewer than those in group PICA at different time points（P0.05）.Conclusion Compared with group PICA,PECA gets a better analgesia and may significantly protect the myocardial.

关 键 词：术后镇痛 冠心病 心肌损伤 胸科手术 

分 类 号：R654.2[医药卫生—外科学] R614[医药卫生—临床医学]