胸段硬膜外阻滞对动脉导管未闭结扎后高血压反应的防治作用

The preventive effect of thoracic epidural block on the rebound hypertension induced by ligation of patent ductus arteriosus

目的 探讨胸段硬膜外阻滞复合全麻及硬膜外镇痛对动脉导管未闭 (PDA)结扎后高血压反应的防治作用。方法 选择 4 0例PDA结扎术的病人 ,随机分为胸段硬膜外阻滞 +异氟醚组(EI组 ,n =2 0 )和异氟醚 +硝普钠 (SNP)组 (IS组 ,n =2 0 )。在吸入 1 8～ 2 2MAC异氟醚时 ,EI组平均动脉压 (MAP)降低 30 %～ 4 0 % ,而IS组需静脉输注SNP时MAP降至相同水平。关胸前分别连接镇痛泵行PCEA和PCIA镇痛 ,记录吸入 1 3MAC异氟醚关胸时、手术结束时、术后 12、2 4、4 8h在镇痛效果相同时MAP、HR变化及血管扩张药使用情况。结果 IS组PDA结扎后 18例需血管扩张药控制MAP升高 ,而HR明显快于EI组 ,4例使用美托洛尔控制SNP治疗期间反应性心率增快 ;EI组PDA结扎后 19例MAP、HR无明显变化 ,仅 1例在手术结束后使用血管扩张药。

Objective To investigate the preventive effect of thoracic epidural block combined with general anesthesia on the rebound hypertension induced by ligation of patent ductus arteriosus(PDA).Methods Forty PDA patients were divided into two groups in random :group EI(isoflurane inhalation combined with thoracic epidural block), group IS(isoflurane combined with sodium nitroprusside).MAP was decreased by 30%-40% in group EI by inhalation of 1.8-2.2 MAC isoflurane,while the same level of MAP as in group EI was obtained by intravenous injection of sodium nitroprusside(0.5-3 μg·kg -1·min -1).PCEA and PCIA were carried out before closing chest in the two groups.The changes in MAP,HR and vasodilator drug use at closing chest,the end of operation,12,24,48 h after operation were recorded.Results 18 patients in group IS needed use vasodilator drug to control the increase of MAP,4 of which need metoprolol to cure reflecting tachycardia during SNP.19 patients in group EI showed no significant changes in MAP and HR.Only one case in group EI received vasodilator drug after operation.Conclusion Thoracic epidural block combined with general anesthesia and post operative epidural analgesia could prevent and cure the rebound hypertension induced by ligation of patent ductus arteriosus.