剖宫产术后硬膜外自控镇痛对妊娠高血压综合征产妇血液流变学的影响

目的观察剖宫产术后硬膜外自控镇痛对妊娠高血压综合征产妇的血液流变学的影响。方法择期行剖宫产的妊高征产妇40例,随机分为2组:术后硬膜外镇痛组(PCEA组)和对照组(C组,不使用术后自控镇痛),每组20例。PCEA组于术后实施硬膜外自控镇痛,C组不使用术后自控镇痛。采用视觉模拟评分(VAS)评价两组产妇术后镇痛效果,采用全自动血液流变仪检测麻醉前(T0)、术后4h(T1)、12h(T2)、24h(T3)、48h(T4)时全血低切、中切、高切黏度和血浆黏度、红细胞聚集指数、纤维蛋白原(Fbg)浓度。结果 PCEA组在术后1、4、8、12、24、48h的VAS明显低于C组(P0.05)。与T0时比较,两组T1、T2、T3、T4时全血低切、中切、高切黏度和血浆黏度、红细胞聚集指数、Fbg增加(P0.05)。PCEA组在T1、T2、T3、T4时全血低切、全血中切、全血高切黏度与血浆黏度、红细胞聚集指数和Fbg明显低于C组(P0.05)。结论妊高征产妇剖宫产术后硬膜外镇痛能有效改善血液流变学状态。

Effect of Patient Controlled-Epidural Analgesia on Hemorheology of Pregnant Women with Pregnancy Induced Hypertension after Caesarean Section

Objective To investigate the effect of patient controlled-epidural analgesia on hemorheology of pregnant women with pregnancy induced hypertension（PIH） after caesarean section.Methods 40 women with PIH undergoing elective cesarean section were randomly and equally divided into two groups：patient controlled-epidural analgesia（PCEA） group（group PCEA） and control group（group C）.Group PCEA was adopted the PCEA after operation,group C without PCEA.The efficacy of analgesia was assessed by visual analogue scale （VAS）.Blood samples were taken before anesthesia （baseline,T 0 ）,4 h after operation（T 1 ）,12 h after operation （T 2 ）,24 h after operation （T 3 ） and 48 h after operation （T 4 ）for determination of blood viscosity,plasma viscosity,erythrocyte aggregation index（EAI）,and fibrinogen.Results The VAS score of group PCEA at 1,4,8,12,24,48 h is lower than group C（ P 0.05）.In group PCEA and C the blood viscosity at low,middle and high shear rate,plasm viscosity,EAI and fibrinogen were increased significantly at T 1-4 as compared to the baseline value at T 0 （ P 0.05）.The blood viscosity at low,middle and high shear rate,plasm viscosity,EAI and fibrinogen were significantly lower at T 1-4 in group PCEA than in group C（ P 0.05）.Conclusions PCEA can ameliorate the hemorheology of pregnant women with pregnancy induced hypertension after caesarean section.