术后自控镇痛对肾移植病人血浆内皮素及肾功能的影响

观察肾移植病人术后硬膜外自控镇痛 (PCEA)对血浆内皮素及肾功能的影响。将 40例慢性肾功能衰竭行肾移植病人随机分成PCEA组 (P组 )和非PCEA组 (N组 ) ,每组 2 0例。两组分别于麻醉前、手术后 2 4、48、72h抽取静脉血 ,采用放射免疫法测定血内皮素、尿素氮、肌酐和尿酸含量。结果显示 ,两组病人术后第 2 4h平均动脉压、血浆内皮素、尿素氮、肌酐、尿酸含量明显下降 ,于术后第 72h达到各自的最低水平 ,但N组各时点的测定值明显高于同时点P组的测定值 (P <0 0 1) ;内皮素与尿素氮、肌酐、尿酸含量有很好的相关性。提示肾移植病人术后应用PCEA能有效消除术后刀口疼痛引起的焦虑、交感神经兴奋导致的少尿 ,从而改善肾功能

EFFECT OF PCEA ON THE SERUM ENDOTHELIN AND THE RENAL FUNCTION AFTER OPERATION IN KIDNEY TRANSPLANTATION PATIENTS

To observe the effect of PCEA on the serum endotheline and the renal function after operation in kidney transplantation patients. Forty patients with chronic renal failure were randomly divided into two groups: group P( n =20) and group N ( n =20) .Venous blood samples were drawn before anesthesia at the end of operation and 24, 48, 72h after operation. Mean arterial pressure (MAP), serum endothelin,creatinine, urea nitrogen, uric acid were measured with radioimmunoassay. The results showed that the MAP, serum endothelin, creatinine, urea nitrogen and uric acid were decreased significantly at 24h after operation.All of them reached the nadir at 72h after operation. But those of group N were significantly higher than group P ( P <0 01). These changes were related linearly. Conclusion: In the patients with kidney transplantation, PCEA not only was able to prevent oliguria as a result of anxiety and sympatheticotonia due to pain,but also improve renal function quickly.