氯诺昔康术后镇痛对二尖瓣置换患者内皮素-1的影响与脑保护

目的 观察术后患者静脉自控镇痛(PCIA)对二尖瓣置换患者血浆内皮素-1(ET-1)水平的影响.方法 将120例ASA分级Ⅱ～Ⅲ级择期行二尖瓣置换手术患者按随机数字表法分为四组,每组各30例,术后接受不同镇痛方法 :L组PCLA氯诺昔康16μg/(kg·h),F组PCIA芬太尼0.2μg/(kg·h),T组PCIA曲马多0.2 mg/(kg·h),D组未行PCIA.记录术后8、12、24和48 h的静息疼痛视觉模拟评分(VAS)和Ramsay镇静评分.于术前及术后8、12、24 h采血检测血浆ET-1水平.结果术后8、12h,L、F及T组VAS均显著低于D组(P<0.05).L组和D组术后各时间点Ramsay镇静评分显著低于F组和T组(P<0.05).L、F及T组患者术后8、12及24h的血浆ET-1水平显著低于D组(P<0.05).L组和D组患者术后嗜睡、恶心、呕吐发生率L组:3.3%(1/30)、3.3%(1/30)、0;D组:均为0]低于F组和T组F组:13.3%(4/13)、13.3%(4/13)、10.0%(3/30);T组:10.0%(3/30)、26.7%(8/30)、16.7%(5/30)](P<0.05).结论 氯诺昔康、芬太尼及曲马多行PCIA均有利于抑制二尖瓣置换术后应激导致的血浆ET-1水平增高,氯诺昔康PCIA更适合于二尖瓣置换术后镇痛.

Effects and brain protection of patient-controlled intravenous analgesia with lornoxicam on plasmaendothelin-1 in patients after mitral valve replacement

Objective To study the effects of patient-controlled intravenous analgesia (PCIA) on plasma endothelin-1 (ET-1) of patients after mitral valve replacement.Methods One hundred and twenty ASA Ⅱ -Ⅲ patients undergoing mitral valve replacement were randomly divided into four groups, 30 cases in each group. The patients were given PC IA with lornoxicam 16 μ g/(kg·h ) in group L, fentanyl 0.2 μ g/( kg·h) in group F, tramadol 0.2 mg/(kg·h) in group T,and without PCIA in group D. VAS score and Ramsay score were recorded at 8,12,24 and 48 h after operation.The plasma ET-1 levels were detected using radioimmunoassay before anesthesia induction,at 8,12 and 24 h after operation.Results VAS scores in group L, F,T were lower at 8,12 h after operation than those in group D,Ramsay scores in group L, D were lower than those in group F,T.ET-1 levels in group L,F and T were significantly lower than those in group D at 8,12 and 24 h after operation (P <0.05).The numbers of dizziness, nausea,vomiting after operation in group L3.3%(1/30) ,3.3%( 1/30),0]and group D(0)were significantly less than those in group F13.3% (4/13), 13.3%(4/13), 10.0%(3/30)]and group T10.0%(3/30), 26.7%(8/30), 16.7%(5/30)](P < 0.05).Conclusion PCIA with lornoxicam is a better method of suppressing the increase of plasma ET-1 levels with less side effects in the patients after mitral valve replacement.