术后硬膜外镇痛和静脉镇痛对老年高血压患者全髋置换术后应激反应的影响

Effects of postoperative epidural and intravenous analgesia on stress response in elder hypertensive patients undergoing total hip replacement

目的比较硬膜外镇痛与静脉镇痛对老年高血压患者全髋置换术后应激反应的影响。方法 30例择期全髋置换术后的高龄患者随机均分为三组:对照组(A组)、术后静脉镇痛(PCIA)组(B组)、术后硬膜外镇痛(PCEA)组(C组)。观察患者术后8、12、24及48h的镇痛效果,记录术前(T1)、术毕(T2)、术后24h(T3)及术后48h(T4)的血流动力学和应激激素的变化。结果 T2～T4时A组的SBP、DBP明显高于、HR明显快于T1时(P<0.05或P<0.01)。T3时B、C组内皮素(ET)、心房利钠肽(ANP)显著低于A组(P<0.05或P<0.01),T4时C组ET明显低于A组,B、C组ANP仍明显低于A组(P<0.05或P<0.01);T3、T4时C组皮质醇(Cor)、促肾上腺皮质激素(ACTH)明显低于A组(P<0.05或P<0.01)。结论 PCEA及PCIA均能有效控制术后疼痛,维持血流动力学稳定,降低术后应激激素水平,而硬膜外镇痛较静脉镇痛对高龄高血压患者镇痛效果更平稳。

Objective To compare the effects of postoperative epidural and intravenous analgesia on stress response in eider hypertensive patients undergoing total hip replacement. Methods Thirty elder hypertensive patients undergoing total hip replacement were divided into three groups： group A（control group）, group B （fentanyl 1 mg＋droperidol 0.5 mg＋NS 100 ml via PCIA）, group C （0. 75% bupivacaine 20 ml ＋ morphine 2 mg＋NS 100 ml）. The analgesic effects, hemodynamics and stress hormones of ET, ANP, Cor and ACTH were recorded. Results Stress hormones of ET, ANP, Cot and ACTH were higher in group A than in group B and C（P〈0.05）. The stress hormones in group C kept constant perioperatively. Conclusion Postoperative analgesia is better via PCEA than via PCIA in elder hypertensive patients undergoing total hip replacement.