胸段硬膜外镇痛对先天性动脉导管未闭术后高血压反应的影响

Effects of thoracic epidural analgesia on postoperative rebound hypertension after ligation of patent ductus arteriosus

目的 探讨胸段硬膜外镇痛（TEA）减轻先天性动脉导管未闭（PDA）术后高血压反应的临床效应。方法 48例PDA手术病人,随机分为对照组（C组,n=22）和试验组（TEA组,n=26）。C组术中应用静吸复合全麻,术后疼痛时间断肌肉注射哌替啶;TEA组术中应用硬膜外阻滞复合全麻,术后硬膜外镇痛。结果 C组PDA结扎后血压显著升高（P<0.05）,18例需用血管扩张剂治疗;TEA组术后血压升高不明显（P>0.05）,仅2例需用血管扩张剂治疗,且组间差异明显（P<0.05）。结论 胸段硬膜外镇痛能有效地控制PDA术后的高血压反应。

Objective To investigate the effects of thoracic epidural analgesia on postoperative rebound hypertension after ligation of patent ductus arteriosus (PDA) . Methods Forty-eight ASA Ⅰ -Ⅱpatients undergoing ligation of PDA were studied. There were 20 male and 28 female. The age ranged from 4-30 years and body weight 15-56 kg. The patients were randomly divided into two groups: general anesthesia group (group C, n= 22) and combined general-epidural anesthesia group (group TEA, n = 26). In group C combined intravenous-inhalational anesthesia was used and intermittent intramuscular pethidine 1 mg·kg-1 was given for postoperative pain relief. In TEA group epidural catheter was placed at T8-9 before induction of general anesthesia and a loading dose of 3-6 ml of a mixture of 0. 125 %-0. 15% bupivacaine + 0.0001% fentanyl + 0.005% droperidol was given 20 min before the end of surgery followed by infusion of the mixture at a rate of 2 ml·h-1. ECG, BP, HR, RR and SpO2 were monitored during and after operation. VAS pain score was evaluated and compared between the two groups. Results Better analgesia was achieved in TEA group. Postoperative blood pressure was significantly higher in group C than that in TEA group (P<0.01). 18 patients in group C needed nitroglycerin or sodium nitroprusside (SNP) to reduce the BP, in TEA group there was no significant increase in BP after operation and only two patients needed nitroglycerin . Conclusion Thoracic epidural analgesia is effective in relieving postoperative pain and reducing postoperative rebound hypertension.