【摘要】 目的研究硬膜外镇痛与静脉镇痛对手术患者恢复期心肌缺血的影响。方法39例行择期腹部手术的患者随机分成两组:硬膜外镇痛组(R组),16例,术中全麻复合硬膜外麻醉,术后硬膜外镇痛;静脉镇痛组(M组),23例,术中全麻,术后静脉吗啡镇痛。维持两组Price-Henry疼痛评分≤3分。所有患者接受24 h动态心电图监测48 h。两组患者在入手术室安静平卧10 min、入SICU后2 h、术后第1天晨、术后第2天晨采集静脉血测定皮质醇浓度。结果术后48 h内,R组心肌缺血发生率比M组低(P<0.05),在术后各时点,R组的皮质醇浓度低于M组(P<0.05)。结论与静脉镇痛相比较,硬膜外镇痛明显减轻应激反应,减少术后心肌缺血发生率。更多还原

【Abstract】 Objective To compare the effect of postoperative epidural analgesia versus intravenous analgesia on myocardial ischemia.Methods Sixteen patients in group R underwent abdominal surgery under general anesthesia combined epidural block and received postoperative epidural fentanyl-ropivacaine analgesia.Twenty-three patients in group M underwent abdominal surgery under general anesthesia and received postoperative intravenous morphine analgesia.The analgesia lasted for 48 h with Price-Henry scores of less than 3 in all patients.Continuous three-lead ambulatory electrocardiographic monitoring was performed during analgesia.Blood samples were taken before anesthesia induction,at 2 h in SICU,on the 1st and 2nd postoperative day for the measurement of cortisol.Results Incidence of myocardial ischemia and plasma cortisol level were higher in group M than those in group R during analgesia(P<0.05).Conclusion Epidural analgesia is better than intravenous analgesia in reducing surgical stress and incidence of myocardial ischemia early after operation.更多还原