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|本期目录/Table of Contents|

吗啡自控镇痛对快通道不停跳冠脉搭桥患者应激反应的影响

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2009年第1期
页码:
107-109
栏目:
临床研究
出版日期:
2009-02-28

文章信息/Info

Title:
Effects of patient-controlled morphine analgesia on stress response in patients after off-pump coronary artery bypass grafting
作者:
孙立新; 侯念果; 王明山; 艾登斌
青岛市市立医院麻醉科，山东 青岛 266071
Author(s):
SUN Li-xin;  HOU Nian-guo;  WANG Ming-shan;  AI Deng-bin
Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao 266071, Shandong, China
关键词:
冠状动脉分流术; 镇痛; 应激
Keywords:
coronary artery bypass;  analgesia;  stress response
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 观察快通道不停跳冠脉搭桥（OPCABG）患者吗啡自控镇痛（PCA）与间断肌注镇痛对应激反应的影响。方法 30例OPCABG手术患者随机分为静脉PCA组（Ⅰ组）和间断肌注镇痛组（Ⅱ组），每组各15例。于术后12、24、36和48 h分别对患者的安静痛和咳嗽痛进行VAS评分；于麻醉前、术中90 min、术后24和48 h测定血糖、血浆胰岛素和皮质醇水平。结果 术后12、24、36和48 h Ⅰ组患者的安静痛、咳嗽痛VAS评分均显著低于Ⅱ组（P<0.01）；术后24和48 h两组患者血浆胰岛素水平明显升高（P<0.05），组间比较差异无显著性；术中90 min后与麻醉前比较，两组患者血糖及皮质醇水平均明显升高（P<0.05），Ⅰ组术后48 h恢复至麻醉前水平，Ⅱ组高水平持续至术后48 h（与麻醉前比较，P<0.05）；组间比较术后血糖、皮质醇水平Ⅰ组显著低于Ⅱ组（P<0.05）。结论 OPCABG手术患者术后吗啡PCA较本文采用的间断肌注镇痛能更有效地减轻术后疼痛及应激反应。
Abstract:
AIM To compare the effect of patient-controlled morphine analgesia (PCA) with intermittent intramuscular analgesia (IM) on the stress response in patients after off-pump coronary artery bypass grafting (OPCABG). METHODS Thirty patients were randomly allocated to PCA group (nⅠ=15) and IM group (nⅡ=15). The patients in groupⅠ received morphine with bolus dose of 2 mg, continued dose of 1mg/h and lock-out time of 15 min while the patients in groupⅡ received morphine 10 mg I.M. per 4 h. The VAS scores of the pain (rest and cough) were observed at the extubation, 12 h, 24 h, 36 h and 48 h after operation and the levels of blood glucose, plasma insulin and cortical were measured before anesthesia, at 90 min after incision and 24 h and 48 h after operation. RESULTS Pain scores of GroupⅠ were significantly lower than those of GroupⅡ at the 12 h, 24 h, 36 h and 48 h after operation (P<0.01). The levels of plasma insulin were markedly elevated at the 24 h and 48 h after operation (P<0.05), no significant difference was observed between the two groups. The levels of blood glucose and cortical of the two groups were raised at 90 min after incision (P<0.05). In groupⅠ, they were restored to the level before anesthesia at the 48 h after operation and in group Ⅱ, they kept at the high levels till 48h after operation. The levels of blood glucose and cortical in groupⅠwere significantly lower than those in GroupⅡ after operation (P<0.05). CONCLUSION Intravenous PCA more effectively alleviates the postoperative pain and stress response than intermittent intramuscular analgesia in patients after OPCABG.

参考文献/References

[1］ Bettex DA, Schmidlin D, Chassot PG, et al. Intrathecal sufentanil morphine shortens the duration of intubation and improves analgesia in fast-track cardiac surgery［J］. Can J Anaesth, 2002, 49(7):711-717.
［2］ Mangano DT, Siliciano D, Hollenberg M, et al. Postoperative myocardial ischemia theoprapeutic trials using intensive analgesia following surgery［J］. Anesthesiology, 1992, 76(3):342-353.
［3］ 蒋宗滨，胡振快，谭冠先，等. 不同剂量芬太尼对不停跳心肺转流心脏手术应激反应的影响［J］. 临床麻醉学杂志， 2003， 19(3)：145-147.
［4］ Mueller XM, Tinguely F, Tevaearai HT, et al. Pain location, distribution, and intensity after cardiac surgery［J］. Chest, 2000, 118(2):391-396.
［5］ Brodner G, Pogatzki E, Van Aken H, et al. A multimodal approach to control postoperative pathophysiology and rehabilitation in patients undergoing abdominothoracic esophagectomy［J］. Anesth Analg, 1998, 86(2):228-234.
［6］ Uchida I, Asoh T, Shirasaka C, et al. Effect of epidural analgesia on postoperative insulin resistance as evaluated by insulin clamp technique［J］. Br J Surg, 1988, 75(6):557-562.

备注/Memo

备注/Memo:
收稿日期：2008-1-9.作者简介：孙立新，主治医师，硕士Email：sunlixin1221@sina.com
更新日期/Last Update: 2009-04-02