术后镇痛对冠心病患者心肌缺血的影响

Effect of postoperative analgesia on myocardial ischemia in the patients with coronary artery disease

目的通过观察冠心病患者术后血浆内皮素(ET-1)、一氧化氮(NO)、6-酮前列腺素F1α(6-Keto-PGF1α)浓度及血压的变化,探讨术后镇痛与心肌缺血的关系。方法胆囊结石合并冠心病患者40例,随机分为A、B两组,硬膜外麻醉复合气管插管全麻,术毕A组接电子镇痛泵,配方为0.125%布比卡因+芬太尼0.01mg/kg+格拉司琼3mg,行硬膜外自控镇痛(PCEA);B组为空白对照组。分别于术前、术毕、术后24h抽静脉血测ET-1、NO、6-Keto-PGF1α血浆浓度。结果A组术后血压平稳,与术前比无明显变化。B组术后24h血压明显升高,收缩压(SBP)、舒张压(DBP)较术前分别升高了16.5%、15.9%。A组和B组ET-1浓度在术后24h较术前均有明显升高,但B组升高更明显(A组为29.2%,B组为77.0%,P<0.01);术后24hA组和B组NO浓度较术前分别降低了33.3%和60.0%,6-Keto-PGF1a浓度分别降低了20.3%和42.0%(P<0.01)。A组术后出现心绞痛及心电图心肌缺血1例,B组6例。结论术后镇痛可减轻手术创伤及术后疼痛引起的舒缩血管物质分泌失衡状态,减少冠心病患者心肌缺血的发生率。

Objective To observe the changes of postoperative serum endothelin-1 （ET-1）, nitrous oxide （NO） and 6-keto-prostaglandin-F1α （6-Keto-PGF1α） concentration and investigate the influence of patient controlled epidural analgesia （PCEA） on coronary artery disease. Methods Forty patients with cholecystolithiasis and coronary artery disease were divided into two groups randomly. After operation,the patients in group A received PCEA, with 0. 125 % bupivacaine, 0. 01 mg/kg fentanyl and 3 mg granisetron,and those in group B were set as the control. The plasma concentrations of ET-1, NO and 6-Keto-PGF1α were detected before operation,at the end of operation and 24 h after operation. Results The postoperative blood pressure in group A was stable, which in group B was increased by 16.5%（SBP） and 15. 9%（DBP） at 24 h after operation. The concentrations of ET-1 in group A and B were increased by 29.2% and 77.0%, of NO reduced by 33.3% and 60. 0%,and 6-Keto-PGF1α reduced by 20. 3% and 42.0% at 24 h after operation（P〈0. 01）. Angina pectoris and myocardial ischemia on ECG occured in one patient of group A and 6 cases of group B. Conclusion Postoperative analgesia reduces the morbility of myocandial ischemia in patients with coronary artery disease.