Objective To investigate the postoperative patient-controlled epidural analgesia in patients with coronary heart disease on the clinical effects of abdomihal surgery.Methods This study selected 60 patients with upper abdominal surgery by clinical diagnosis with coronary heart disease.Patients were randomly divided into two groups:epidural analgesia group (I group)and intravenous analgesia group(Ⅱ group),with 30 cases for each group.All patients were treated with endotracheal anesthesia,group of postoperative epidural analgesia,Ⅱ group of postoperative analgesia,the two groups were recorded the mean arterial pressure(MAP),heart rate(HR),pulse oxygen saturation(SpO2),serum troponin-I(cTn-I)before and after anesthesia and postoperative 4 h,12 h,24 h and 48 h,postoperative analgesic effect was conducted using the visual analogue scale(VAS)assessment of analgesia.Results As compared with the pre-operation level,no significant difference was observed in the MAP,HR,SpO2,cTn-I after surgery in group Ⅰ(P＞0.05);Ⅱ group of post-operative MAP,HR,cTn-I were significantly higher(P＜0.05),SpO2 Was significantly lower(P＜0.05).Compared with group Ⅱ,Ⅰgroup ofpost-operative MAP,HR,cTn-I,VAS score were lower(P＜0.05),SpO2 was higher(P＜0.05).Conclusion The postoperative patient-controlled epidural analgesia in patients with coronary heart disease with abdominal surgery,can effectively eliminate the postoperative pain,reduce stress,maintain hemodynamic and cTn-I in blood stability,and has a protective effect on myocardial injury.%目的 观察术后硬膜外自控镇痛应用于冠心病患者上腹部手术的临床效果.方法 本研究选择行上腹部手术、临床确诊为冠心病患者60例,随机分为两组:硬膜外镇痛组(I组)和静脉镇痛组(Ⅱ组).每组各30例.所有患者均采用气管内全麻,Ⅰ组术后应用硬膜外镇痛,Ⅱ组术后应用静脉镇痛,记录两组患者麻醉前及术后4h、12 h、24 h、48h的平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO2),检测血清肌钙蛋白-I(cTn-I),术后采用视觉模拟评分法(VAS)评定镇痛效果.结果 与麻醉前比较,Ⅰ组术后的MAP、HR、SpO2、cTn-I未见明显变化,差异均无显著性(P＞0.05); Ⅱ组术后的MAP、HR、cTn-I显著升高(P＜0.05),SpO2显著降低(P＜0.05).与Ⅱ组比较,Ⅰ组术后的MAP、HR、cTn-I、VAS评分均较低,差异均有显著性(P＜0.05);SpO2较高,差异有显著性(P＜0.05).结论 在行上腹部手术的冠心病患者,术后应用硬膜外自控镇痛能较好地消除患者术后疼痛,减少应激反应,维持血流动力学及血清cTn-I稳定,对心肌损伤有一定的保护作用.
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