术后病人自控镇痛对老年胸科手术患者心肌酶谱及心肌肌钙蛋白T的影响

Effects of Patient Controlled Analgesia on Myocardial Enzymogram and Troponin T of the Myocardium in Old Patients with Thoracic Surgery

目的：研究术后自控镇痛方法对老年胸科手术患者心肌酶谱及心肌肌钙蛋白T（cTnT）的影响。方法：选择40例、ASAⅠ-Ⅱ级、择期在全身麻醉下行开胸手术的老年患者,按术后镇痛方法的不同随机分为两组,即患者静脉自控镇痛（PCIA）组和患者硬膜外自控镇痛（PCEA）组。两组均于手术开始前、术毕、术后6、24、48h早晨7点抽左肘静脉血3m l,检查血清肌酸激酶（CK）、肌酸激酶同工酶（CKMB）、谷草转氨酶（AST）、乳酸脱氢酶（LDH）及cTnT的含量。同时比较两组的镇痛效果。结果：①PCEA组镇痛效果优于PCIA组。②PCIA组CK、AST、LDH术后均明显高于术前（P〈0.05）,PCEA组除LDH术后12h高于术前外（P〈0.01）,其它指标均无明显差异（P〉0.05）;PCEA组术后CK、AST、LDH均显著低于PCIA组（P〈0.05）。③二组术后6、24及48h的cTnT含量均显著升高（P〈0.05或0.01）,但PCEA组的上述指标均明显低于PCIA组（P〈0.05）。结论：PCEA组镇痛效果优于PCIA组,且PCEA比PCIA更能减少老年患者围术期的心肌损害。

Objective： To observe the effects of patient controlled analgesia on myocardial enzymogram and troponin T of the myocardium in old patients with thoracic surgery. Method ： 40 old patients , aged 66 to 72 years, ASA Ⅰ-Ⅱ, undergoing selective thoracic surgery under general anesthesia, were randomly allocated to two groups（PCIA group and PCEA group ）. Serum CK, CKMB, AST , LDH and cTnT concentrations were measured before anesthesia , at the end of operation and at 12, 24, 48 hours after operation. Result： Two groups can reduce postoperative pain, but PCEA group was superior to PCIA group. Serum CK, AST, LDH and cTnT concentration in PCIA group after operation were significantly higher than those before anesthesia （ P 〈 0.05）. In PCEA group, serum LDH and cTnT concentration were obviously higher than those before anesthesia（P 〈0.05）. Serum CK, AST, LDH and cTnT concentration in PCIA group were higher than those in PCEA group after operation （ P 〈 0.05 ）. Conclusion ： PCEA has better effect in protecting myocardium after operation than PCIA.