氯诺昔康复合芬太尼对冠心病患者术后心肌缺血和血小板功能的影响

Effects of lornoxicam combined with fentanyl on postoperative myocardial ischemia and platelet function in patients with coronary heart disease

目的探讨氯诺昔康复合芬太尼对冠心病患者术后心肌缺血和血小板膜糖蛋白表达的影响。方法择期妇科手术患者100例,均有冠心病诊断,随机均分为两组,采用相同麻醉诱导及维持用药。术中及术后A组用氯诺昔康复合芬太尼镇痛,B组用芬太尼镇痛。记录术后VAS疼痛评分,监测术后1-8d动态心电图S-T改变,检测血小板计数(Plt)、凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血酶时间(APTT)及血小板表面CD41/CD61、CD62P、CD63的表达量。结果两组术后4、12、24、48hVAS疼痛评分均<3分。A组术后第8天心肌缺血发生率明显比B组少(P<0.05),且A组血小板膜上的CD41/CD61、CD62P、CD63表达量明显低于B组(P<0.05)。结论氯诺昔康复合芬太尼镇痛可有效降低冠心病患者术后心肌缺血发生率,可能与其抑制血小板活化有关。

Objective To investigate the effects of lornoxicam combined with fentanyl on postoperative myocardial ischemia and platelet function in patients with coronary artery disease （CHD）. Methods One hundred CHD patients undergoing selective gynecologic surgery were equally randomized into two groups of A （given lornoxicam combined with fentanyl for postoperative analgesia） and B（given fentanyl only）. The VAS pain score was assessed in 48 hours after surgery. The changes of S-T segment were detected by Holter monitor in 1 to 8 days after operation. Blood samples were taken for the examinations of CD62p,CD63 and CD41/CD61 on the platelet membrance suface, platelet counts（Pit）,thrombin proenzyme time（PT）, thrombin time（TT）, and part thrombin time（APTT）. Results VAS scores of two groups were all less than 3 points during postoperative analgesia. The incidence of myocardial ischemia in group A was significantly lower in group A than that in group B on the 8th day after operation（P^0. 05） ,and the expressions of CD41/CD61 ,CD62p, CD63 in group A were significantly lower than those in group B as well（P^0. 05 or 0. 01）. Conclusion Lornoxicam combined with fentanyl therapy can effectively reduce the incidence of postoperative myocardial iischemia in CHD patients undergoing gynecologic surgery, which may be through an inhibitory effect on the activation of platelet.