硬膜外镇痛与静脉镇痛用于妊娠合并心脏病者术后镇痛的临床研究

摘要

目的 探讨硬膜外自控镇痛(PCEA)与静脉自控镇痛(PCIA)用于妊娠合并心脏病者术后镇痛的临床价值.方法 回顾性分析本院86例妊娠合并心脏病者患者的临床资料,按随机数表法均分为观察组(PCEA)与对照组(PCIA).记录两组术后镇痛效果,分析术后即刻及术后12 h、24 h、72 h血流动力学指标(MAP、HR)、炎症因子(IFN-γ、IL-4、IL-8、IL-10)水平变化,并记录镇痛期间不良反应发生率.结果 两组术后12h、24 h、72h的VAS评分比较,差异均无统计学意义(均P＞0.05).观察组术前及术后各时点MAP、HR比较,差异均无统计学意(均P＞0.05);对照组术后12 h、24 h的MAP、HR均高于术前(均P＜0.05).观察组术后12 h、24 h的MAP分别为(87.34±3.17) mmHg、(87.39±3.25) mmHg,HR分别为(75.35±8.90)次/min、(75.10±7.95)次/min,均低于对照组(均P＜0.05).两组术后12h、24 h、72 h的TNF-0、IL-8均高于术后即刻,IL-4、IL-10低于术后即刻(均P＜ 0.05).观察组术后12h、24h、72 h的TNF-α分别为(6.42±1.39) pg/ml、(6.75±1.43)pg/m、(6.20±1.12) pg/ml,IL-8分别为(8.10±1.35) pg/ml、(8.34±1.42) pg/ml、(7.95±1.45) pg/ml,均低于对照组,IL-4分别为(11.79±1.62) pg/ml、(11.85±1.64) pg/ml、(11.64±1.82) pg/ml,IL-10分别为(30.46±3.69) pg/ml、(29.10±3.42)pg/ml、(29.05±3.54) pg/ml,均高于对照组;两组比较差异均有统计学意义(均P＜ 0.05).观察组不良反应发生率为16.28％,低于对照组的39.53％(x2=5.780,P=0.016).结论 PCEA与PCIA用于妊娠合并心脏病者术后镇痛效果均较好,但前者能更好地维持血流动力学稳定,降低炎症因子水平,不良反应少,安全性高,具有较好的临床应用价值.%Objective To investigate the clinical value of patient-controlled epidural analgesia (PCEA) versus patient-controlled intravenous analgesia (PCIA) for postoperative analgesia in pregnant women with heart disease.Methods The clinical data of pregnant 86 patients with heart disease were retrospectively analyzed.The patients were randomly divided into an observation group (PCEA) and a control group (PCIA),43 cases for each group.The analgesic effects of the two groups were recorded.Immediately and 12,24,and 72 h after the operation,the hemodynamic indexes [mean arterial pressure (MAP) and heart rate (HR)] and inflammatory factors [interferon gamma (IFN-gamma),interleukin-4 (IL-4),interleukin-8 (IL-8),and interleukin-10 (IL-10)] were analyzed.The incidence of adverse reactions during analgesia was recorded.Results There were no statistical differences in the VAS scores between these two groups 12,24,and 72 h after the operation (all P＞0.05).There were no statistical differences in the MAP and HR in the observation group between before and after the operation (all P＞0.05).The MAP and HR were higher 12 and 24 h after than before the operation in the contol group.12 and 24 h after the operation,the MAP were (87.34 ± 3.17) mmHg and (87.39 ± 3.25) mmHg and the HR were (75.35± 8.90) times/min and (75.10 ± 7.95) times/rain in the observation group,which were lower than those in the control group (all P＜0.05).The levels of TNF-t and IL-8 were higher and the levels of IL-4 and IL-10 were lower 12,24,and 72 h than immediately after the operation in both groups (all P＜0.05).12,24,and 72 h after the operation,the levels of TNF-αtwere (6.42 ± 1.39) pg/ml,(6.75 ± 1.43) pg/ml,and (6.20 ± 1.12) pg/ml and the levels of IL-8 (8.10 ± 1.35) pg/ml,(8.34 ± 1.42) pg/ml,and (7.95 ± 1.45) pg/ml in the observation group,which were lower than the control group (all P＜0.05).12,24,and 72 h,the levels of IL-4 were (11.79 ± 1.62) pg/ml,(11.85± 1.64) pg/ml,and (11.64 ± 1.82) pg/ml and the levels ofIL-10 were (30.46 ± 3.69) pg/ml,(29.10 ± 3.42) pg/ml,and (29,05 ± 3.54) pg/ml in the observation group,which were higher than those in the control group (all P＜0.05).The incidence of adverse reactions was 16.28％ in observation group and 39.53％ in the control group (x2=5.780,P=0.016).Conclusions PCEA and PCIA are better for postoperative analgesia in pregnant women with heart disease.But the former can better maintain the hemodynamic stability and reduce the levels of inflammatory factors.It has fewer adverse reactions,higher safety,and better clinical value.