不同镇痛方法对动脉导管未闭结扎术后高血压反应的影响

THE EFFECT OF DIFFERENT ANALGESIA METHODS ON POSTOPERATIVE REBOUND HYPERTENSION AFTER LIGATION OF PATENT DUCTUS ARTERIOSUS

目的 :观察不同镇痛方法对动脉导管未闭 (PDA)结扎术后高血压反应的影响。方法 :4 0例择期行PDA结扎术的病人 ,随机分为两组 ,术后硬膜外镇痛组 (PCEA组 ,n =2 0 ) ,术后静脉镇痛组(PCIA组 ,n =2 0 ) ,观察手术结束时、术后 12、2 4、4 8h在镇痛效果相同时血压、心率变化及血管扩张药使用情况。结果 :镇痛组间VAS评分差异无显著性 (P >0 .0 5 )。PCIA组PDA结扎术后高血压显著增高 (P <0 .0 1) ,19例 (95 % )需血管扩张药治疗 ,心率显著快于PCEA组 ,6例使用美托洛尔控制硝普钠 (SNP)治疗期间反应性心率增快。而PCEA组仅 7例术后出现高血压 ,2 0例心率无明显变化 ,其术后 4 8h应用SNP和巯甲丙脯酸 (CAP)剂量也显著低于PCIA组 (P <0 .0 1)。结论

Objective: To compare the effect of different analgesia methods on the rebound hypertension after ligation of patent ductus arteriosus (PDA). Methods: Forty PDA patients undergoing ligation of PDA were divided into two groups randomly,i.e. group PCEA (n=20) and group PCIA (n=20). In group PCEA, patient-controlled epidural analgesia was performed to relieve postoperative pain. Patient-controlled intravenous analgesia was performed in group PCIA. The changes of MAP, HR and the dosages of vasodilators at the end of operation, 12, 24 and 48h after operation were recorded. Results: There was no significant difference for VAS scores between the two groups. 19 patients (95%) in group PCIA while 7 patients (35%) in group PCEA needed vasodilators to control hypertension after operation ( P <0.01), 6 patients needed metoprolol to control reflecting tachycardia during SNP in group PCIA. There was no significant changes for MAP and HR between before and after operation in group PCEA. The dosages of SNP and CAP were significantly higher in group PCIA than that in group PCEA. Conclusions: Thoracic epidural analgesia can effectively prevent the rebound hypertension after ligation of PDA.