妊高征患者剖宫产术后硬膜外自控镇痛对一氧化氮和内皮素的影响

Effects of postoperative patient controlled epidural analgesia on serum nitric oxide and plasma endothelin levels in patients with pregnancy-induced hypertension undergoing cesarean section

目的 探讨硬膜外自控镇痛(PCEA)对妊高征患者剖宫产术后血清一氧化氮(NO)和血浆内皮素(ET)的影响。方法 20例中、重度妊高征患者随机分成两组,Ⅰ组术后采用PCEA,Ⅱ组术后肌注哌替啶。于术前、术毕、术后24 h和48 h记录收缩压(SBP)、舒张压(DBP)和心率(HR),并抽取肘静脉血测NO和ET。结果 两组患者术毕、术后24 h和48 h的SBP和DBP均较术前明显降低(P<0.05,P<0.01),术后24 h和48 h Ⅰ组较Ⅱ组降低明显(P<0.05),各时期HR无明显变化(P>0.05);两组患者术毕、术后24 h和48 h ET较术前明显降低(P<0.05),Ⅰ组术后24 h和48h较Ⅱ组降低明显(P<0.05);两组术毕NO较术前明显降低(P<0.05),术后24 h和48 h又恢复到术前水平,两组间无显著性差异(P>0.05)。结论 PCEA能降低妊高征患者剖宫产术后ET水平,并使血压降低,对NO无明显影响。

Objective To investigate the effects of postoperative patient controlled epidural analgesia(PCEA) on serum nitric oxide (NO) and plasma endothelin (ET) levels in patients with pregnancy-induced hypertension (PIH)undergoing cesarean section. Methods Twenty patients with moderate or severe PIH were randomly divided into two groups with 10 cases each. The patients in group Ⅰ received PCEA while intramuscular pethidine was used for postoperative analgesia in group Ⅱ . Blood samples were obtained before operation,at the end of operation,24 h and 48 h after operation to determine NO and ET. Systolic blood pressure(SBP) ,diastolic blood pressure(DBP) and heart rate(HR )were recorded simultaneously. Results SBP and DBP decreased significantly at the end of operation,24 h and 48 h after operation compared with those before operation in both groups(P< 0. 05,P<0. 01) , which were much lower in group Ⅰ than those in group Ⅱ (P<0. 05). ET decreased significantly at the end of operation,24 h and 48 h after operation in both groups(P<0. 05), which was much lower in group Ⅰ than that in group Ⅱ (P<0. 05). The levels of NO decreased significantly at the end of operation(P<0. 05)and restored to those before operation at 24 h and 48 h after operation in both groups, which was not obviously different between two groups. Conclusion PCEA can decrease plasma ET levels and blood pressure in patients with PIH,but has no effect on NO levels.