【摘要】 [目的]探讨多模式术后镇痛对心脏病人行非心脏手术围术期心肌保护及其作用机制。[方法]合并高血压、缺血心脏病病人择期行胃、胆道手术60例。均施行静吸复合全麻。根据术后镇痛方式不同,随机分为静脉自控镇痛(PCIA)I组(n=20),硬膜外自控镇痛(PCEA)E组(n=20),以及未作预镇痛处理组N组(n=20)。I组和E组术毕依据不同镇痛方法注入各自镇痛液5ml,接上镇痛装置,待病人清醒拔管后送返病房。分别于进入手术室(T0)、术毕即刻(T1)、术后24h(T2)、术后48h(T3),取外周血测定肌钙蛋白I(cTnI)及皮质醇浓度(Cort),并对镇痛效果行视觉模拟评分(VAS),观察不良反应。[结果]肌钙蛋白I、皮质醇浓度组间比较(T2、T3)N组较I、E二组差异有统计学意义,组内比较(T2)I、N二组较(T0)差异有统计学意义。VASI、E二组均表示镇痛良好。不良反应E组较I、N二组少。[结论]硬膜外术后镇痛对围手术期心脏病人非心脏手术心肌有良好的保护,可能与适度抑制交感神经活性有关。更多还原

【Abstract】 [Objective]To investigate the multi-modal postoperative analgesia on heart disease for perioperative myocardial protection in noncardiac surgery and its mechanisms.[Methods]Stomach,biliary tract surgeries were carried out among 60 patients with hypertension and ischemic heart disease.And all were given with inhalation anesthesia.According to postoperative analgesia in different ways,patients were randomly divided into PCIA(I)group(n = 20),PCEA group(E)(n = 20),and without pre-pain group(N)(n = 20).After the surgery,I group and E group were injected into 5ml analgesic solutions according to different analgesia methods,then connected to the analgesia device and returned to the wards after extubation.Respectively,at the time of into the operating room(T0),after surgery immediately(T1),after 24 hours(T2),after 48 hours(T3),detected peripheral blood measured troponin I(cTnI)and cortisol(Cort),and evaluated analgesic effects with visual analogue scale(VAS),observed adverse reactions.[Results]Troponin I,cortisol levels(T2,T3)in N group were different with those in I and E groups,within the comparison group(T2),there were differences in troponin I,cortisol levels at time of T2 in I and N groups,comparing at time of T0.VAS showed a good analgesic effect in I,E groups.Adverse reactions in E group were less than in I,N groups.[Conclusion]The postoperative epidural analgesia has a good myocardial protection on heart disease patients during non-cardiac surgery,which may be related to a moderate inhibitory of sympathetic activity.更多还原