两种不同止痛方案对二尖瓣置换术术后患者应激状态的影响

Effects of Two Different Analgesic Protocols on Postoperative Stress of Patients Undergoing Mi-tral Valve Replacement

目的 探讨芬太尼经静脉自控止痛（ＰＣＡ）对二尖瓣置换术（ＭＶＲ）术后患者应激状态的缓解作用。方法６０名ＭＶＲ 患者随机分为 ２组，ＣＡＴ组为常规止痛组，术后按需给予吗啡 ０．１０～０．２０ ｍｇ／ｋｇ静脉注射；ＰＣＡ组为术后使用 ＰＣＡ给药装置持续输入芬太尼 ５０ μｇ／ｍｌ，持续背景输入速度 ２５ μｇ／ｈ，单次给药剂量 ２５ μｇ，锁定时间 １５ ｍｉｎ。术后 ４８ ｈ内观察止痛效果，术前 ２４ ｈ、术后 ２４ｈ，４８ ｈ测定血糖水平和尿去甲肾上腺素水平。结果 ＰＣＡ组术后止痛效果明显好于 ＣＡＴ组，术后 ２４ ｈ血糖水平 ＣＡＴ组明显高于ＰＣＡ组（Ｐ＜０．０５），术后２４ ｈ，２４～４８ ｈ ＣＡＴ组尿ＮＡ水平均明显高于ＰＣＡ组（Ｐ＜０．０５）。结论 芬太尼经静脉ＰＣＡ用于ＭＶＲ术后患者可以明显缓解术后应激状态，有利于术后康复。

To evaluate the stress level of patients undergoing mitral valve replacement(MVR) who received different postoperative analgesic protocols. 60 MVR patients were divided into two groups: Group A using conventional analgesic treatment ,and group B using Fentany. Analgesic ef-fect, blood glucose and urine NA were observed before and 48 h after operation. The results showed that Fentany markedly alleviated stress of the MVR patients,thus facilitating postoperative recov-ery of these patients.