硬膜外镇痛对冠心病患者手术后应激反应和心电图的影响〖

目的　观察冠心病患者上腹部手术后硬膜外镇痛（Epidural, EP）对机 体应激反应及心电图的影响. 方法　比较术后EP与肌注哌替啶（MI）的镇痛效果，检测围术期患者血清皮质醇、胰岛素、血糖和心电图 的变化情况. 结果　①镇痛效果：EP组优于MI组(1.56±0.53) vs ( 4.22±1.74), P<0.01]；②术后血清皮 质醇、胰岛素和血糖浓度：EP患者明显低于MI患者(P<0.05)；③术后10和24 h ST段压低导联数和ST段压 低值总和：EP组趋于减少，MI组则明显多于术前水平和EP组(P<0.05). 结论　冠心病患 者上腹部手术后硬膜外镇痛明显减轻术后疼痛应激反应并减少心肌缺血的发生.

Postoperative epidural analgesia reduces stress response and improves m yocardial ischemia in CHD patients

AIM　To compare the effects of postoperative epidura l single bolus bupivacaine analgesia (EP group) with intramuscular injection (MI group) of pethidine after upper abdominal oper ation on stress response and electrocardiogram in patients with coronary heart disease. METHODS　 WTBZ Patients were followed up at 6, 10, 24 h after operation and the degree of pain, the change of ECG, the levels of cort isol, insulin and blood sugar were assessed. RESULTS　① Efficacy of pain relief in EP group was superior to that in MI group (1.56±0.53) vs (4.22±1.74), P<0.01]; ② Levels of cortisol, insulin, blood sugar in MI grou p were markedly higher than those in EP group (P<0.05). ③ At postoperative 10 h and 24 h the sites of ST depression and total ST depression of 12 sites of ECG in MI group significantly increased as compared with preoper ative values and those of EP group (P<0.05). CONCLUSION　Postop erative epidural analgesia can markedly reduce the stress response and improve myocardial ischemia in patients with cor onary heart disease undergoing upper abdominal operation.