冠心病非心脏手术后不同镇痛方法对心肌缺血的影响

EFFECTS OF DIFFERENT ANALGESIC ON MYOCARDIAL ISCHEMIA IN PATIENTS WITH CORONARY HEART DISEASE UNDERGOING NONCARDIAC SURGERY

目的:观察冠心病(CHD)患者非心脏手术后不同镇痛模式对其心肌缺血(M I)的影响。方法:将CHD术后患者分成三组,硬膜外自控镇痛(PCEA)组、肌注组和对照组。以动态心电图(DCG)监测CHD非心脏手术患者169例,术后监测至少48 h。记录术后M I发生率、平均每小时M I次数、M I持续时间、M I曲线下面积以及VAS评分。结果:PCEA组镇痛效果好,并且可以有效地降低术后M I发生率、平均每小时M I次数、M I时间以及M I曲线下面积,与其它两组比较有显著性差异(P<0.01)。结论:术后完善的镇痛很有必要,可以减少CHD患者非心脏手术后M I的发生。

Objective： To observe effects of different analgesics on myocardial ischemia （MI） in patients with coronary heart disease （CHD） undergoing noncardiac surgery. Methods： 169 patients were divided into three groups, patient contralled epidural analgesia（PCEA） group, IM group and control group. The incidence of MI, the number of ischemic episodes per hour, the duration of MI, the area under the curve per hour and VAS scores were recorded for at least 48 hours aiier surgery. Results： Systemic relieving pain using PCEA availably reduced the incidence of MI, the number of ischemic episodes per hour, the duration of MI, the area under the curve per hour and VAS scores. There was significant difference between PCEA group and the other groups （P 〈 0.01 ）. Conclusion ： Perfect relieving pain is necessary after surgery and can reduce MI in CHD patients undergoing noncardiac surgery.