吗啡复合罗哌卡因硬膜外腔术后镇痛对高血压病患者应激反应的影响

Effects of PCEA with morphin plus ropivacaine on stress responses in patients with hypertension

目的探讨吗啡复合罗哌卡因硬膜外自控术后镇痛对高血压病患者内皮素(ET),肾素-血管紧张素-醛固酮系统(RAAS)的影响。方法40例拟行腹式全子宫切除术的高血压病患者随机分为两组:A组为对照组,术后根据需要间断肌注哌替啶镇痛;B组术后行吗啡复合罗哌卡因硬膜外自控术后镇痛(PCEA)。采用放免法测定术前、术毕3h、术后24h及术后48h血浆ET、肾素活性(PRA)及血管紧张素Ⅱ(AngⅡ)浓度;监测心率、血压及VAS评分。结果B组术毕3h、术后24h及48h血浆ET值显著低于A组(P<0.01),而且B组术毕3h及术后24h血浆PRA,AngⅡ值低于A组,B组术后收缩压(SBP)及VAS评分显著低于A组同期值(P<0.01)。结论吗啡复合罗哌卡因硬膜外自控术后镇痛,能有效减轻病人疼痛,抑制高血压患者ET、PRA和AngII释放和应激反应,维持血流动力学稳定。

[Objective] To observe the effects of patient controlled epidural analgesia（PCEA） with morphine plus ropivacaine on levels of plasma endothelin（ET）, plasma renin aetivity（PRA）and angiotensin Ⅱ （Ang Ⅱ ）in patients with hypertension. [Methods] Forty cases with hypertension undergoing total abdominal hysterectomy, operation were randomly divided into 2 groups： group A, served as control, pethidine 50 mg im intermittently after operation according to requirement;group B, PCEA with morphine and ropivacaine was carried out after operation.The plasma levels of ET, PRA and Ang Ⅱ before operation, at 3h, 24 h and 48 h after operation were estimated by radioimmunoassay. Heart rate （HR） and blood pressure （BP） were monitored and VAS was assessed. [Results] The plasma levels of ET at 3h, 24 h and 48 h after operation in group B were significandy lower than those in group A（P 〈0.01）. PRA and Ang Ⅱ at 3h and 24 h after operation in group B were significantly lower than those in group A. VAS and systolic BP（SBP） after operation in group B obviously decreased as compared with those of the same period in group A（P 〈0.01）. [Conclusion] PCEA with morphine plus ropivacaine can effectively reduce the pain.PCEA can inhibit the release of ET, PRA and Ang Ⅱ, suppress stress responses in patients with hypertension and stabilize the hemodynamic parameters.