急性心肌梗塞患者自控硬膜外镇痛对血清心肌肌钙蛋白T的影响

目的　观察急性心肌梗塞 (AMI)患者进行自控硬膜外镇痛 (PCEA)治疗期间血清心肌肌钙蛋白 T(c Tn T)的变化。方法　选择 18例 AMI患者随机分成两组 ,A组 (n=9)选择 T2～ 3行常规硬膜外穿刺置管成功后 ,推注 0 .2 5 %丁哌卡因 5 ml,测定阻滞平面为 T1～ 5 观察 30分后接 PCA泵持续治疗 10天。PCEA治疗模式采用 L CP模式。 B组 (n=9)不用 PCEA治疗 ,用止痛药解除疼痛 ,其它治疗两组相同。结果　两组病人发病后血清 c Tn T均升高 ,A组病人治疗后下降明显 ,6天左右降到正常值水平。B组病人血清中高浓度 c Tn T持续时间长 ,第 10天仍高于正常值。结论　 PCEA治疗 AIM能明显降低血清 c Tn T浓度 ,提示 PCEA有缓解心肌缺血 ,治疗缺血性心肌病的作用。

Changes of serum cardiac troponin T levels during patient-controlled epidural analgesia in patients with acute myocardial infarction

Objective To observe the effects of patient controlled epidural analgesia(PCEA)on serum cardiac troponin T (cTnT) level in acute myocardial infarction(AMI).Methods Eighteen AMI patients were randomly divided into A and B group.In A group,high epidual blockade at T 2 3 was performed by injecting 5ml 0.25% bupivacaine,30 min later PCEA was applied for 10 successive days.In B group,only morphine or dolantine was administered intramuscularly.Results The elevated cTnT level decreased significantly 3 days later and returned to normal range 6 days following PCEA,but in B group,the cTnT level was higher than the normal range 10 days following treatment.Conclusion PCEA can lower the elevated cTnT level in AMI patients to protect myocardium from ischemia injury.