【摘要】 目的　观察冠心病病人上腹部手术后硬膜外镇痛 (EA)对皮质醇、胰岛素及心电图的影响。方法　比较术后 2 4小时EA与肌注镇痛 (MI)的镇痛效果 ,观察心电图及血清皮质醇、胰岛素和血糖的变化。结果　 (1)EA镇痛效果优于MI组 (VAS :1 5 6± 0 5 3和 4 2 2± 1 74) (P <0 0 1)。 (2 )术后血清皮质醇、胰岛素和血糖浓度EA病人明显低于MI病人 (P <0 0 5 )。 (3)EA组术后ST段压低导联数和压低值总和趋于减少 ;MI术后 10小时和 2 4小时ST段压低导联数和压低值总和明显高于术前水平 (P <0 0 5 ) ,并高于EA组 (P <0 0 5 )。结论　冠心病病人上腹部手术后硬膜外镇痛明显减轻术后皮质醇过度分泌并减少心肌缺血的发生更多还原

【Abstract】 Objective To compare the effect of postoperative epidural single dose bupivacaine analgesia (EA group) with intramuscular injection (MI group) of pethidine after upper abdominal operation on stress response and electrocardiogram in patients with coronary heart disease.Methods The patients were followed up at 6,10 and 24 h after operation and the degree of pain,the change of ECG,the levels of cortisol,insulin and blood sugar were assessed.Results (1)The efficacy of pain relief in EA group was superior to that in MI group(1 56±0 53 vs 4 22±1 74).(2)The levels of cortisol,insulin and blood sugar in MI group were markedly higher than those in EA group.(3)At postoperative 10 h and 24 h,the leads and degree of ST depression of 12lead ECG in MI group were significantly more than preoperative values and those in EA group.Conclusion Postoperative epidural analgesia can markedly reduce the stress response and improve myocardial ischemia in patients with coronary heart disease undergoing upper abdominal operation.更多还原