不同术后镇痛方法对血浆肾素-血管紧张素Ⅱ-醛固酮系统的影响

Influence of postoperative analgesic method on plasma renin-angiotensin-aldosterone system in patients undergoing hysterectomy

目的 :观察不同术后镇痛方法对子宫切除术患者血浆肾素 血管紧张素 醛固酮 (R A A)系统的影响。方法 :将 36例ASAⅠ～Ⅱ级子宫切除术患者 ,随机分为持续硬膜外输注镇痛 (CEA)组、持续静脉输注镇痛 (CIA)组和哌替啶肌注镇痛 (MA)组 ,每组 12例。分别于麻醉前 (T0 )、术毕使用镇痛药前 (T1)、术后 4小时(T2 )和术后第一天晨 7时 (T3 )采静脉血测定血浆肾素、血管紧张素Ⅱ和醛固酮浓度。结果 :与T0 比较 ,肾素水平CEA组、CIA组在T3 升高 ,MA组在T2 显著降低 (P <0 .0 1) ;血管紧张素ⅡCEA组在T2 、T3 和MA组在T3均显著降低 (P <0 .0 1) ;醛固酮CEA组在T3 显著降低 (P <0 .0 1) ,MA组在T2 升高 (P <0 .0 1) ,而T3 时降低(P <0 .0 1)。组间比较 ,CEA组、MA组在T2 和T3 时肾素、血管紧张素Ⅱ、在T3 时醛固酮浓度显著低于CIA组(P小于 0 .0 5或 0 .0 1)。结论 :CIA患者R A A系统较稳定 ,CEA患者R A A系统被抑制。

Objective:To study the effects of postoperative analgesia on plasma renin angiotensin aldosterone(R A A)system in patients undergoing hysterectomy.Methods:Thirty six patients,ASA gradeⅠ~Ⅱ,scheduled for elective hysterectomy ,were randomly divided into continuous epidural analgesia(CEA),continuous introvenous analgesia(CIA) and traditional meperidine intramuscular analgesia(MA) groups. Plasma renin,angiotensin and aldosterone concentrations were measured before anesthesia(T 0),operation over and before analgesia(T 1),4h after operation(T 2),and 7o'clock of next day after surgery.Results:Compared with T 0 ,renin levels at T 3 were significantly higher in CEA and CIA groups (P<0.05),but in MA group, it was markedly low at T2 (P<0.01),Angiotensin concentrations at T 2 and T 3 were significantly low in CEA group(P<0.01),and significantly low at T 3 in MA group(P<0.01),aldosterone constrations increased significantly in three groups at T 1(P<0.05 or 0.01),but decreased markedly at T 3 in CEA group(P<0.01),rose significantly at T 2 and fell significantly at T 3 in MA groups(P<0.01).Aldosterone in CEA was markedly lower than that in MA at T 2 ( P < 0.05).Among three groups, renin and angiotensin concentration at T 2,T 3 ,aldosterone concentration at T 3 in CEA and MA groups were markedly lower than that in CIA group.Conclusion:R A Asystem is stabilization in CIA group.In CEA,the value of R A A system is inhibited.