摘要
目的 观察术后硬膜外自控镇痛 (PCEA)对全髋置换术患者的血液流变学的影响。方法 ASAⅠ～Ⅱ级行择期全髋置换手术患者 2 6例 ,随机分为PCEA组和对照组 ,每组均为 13例。 2 6例均行连续硬膜外麻醉。PCEA组于手术结束后经硬膜外腔注入吗啡 0 5mg ;后接PCA泵 ,镇痛液配方用吗啡 5mg +布比卡因 12 5mg +氟哌利多 2 5mg ,以生理盐水稀释至 10 0ml。背景速度2ml/h ,PCA剂量 0 5ml,锁定时间 15min。对照组病人则视术后疼痛情况间断肌注哌替啶。结果(1)术后 1、12、2 4、4 8hVAS评分PCEA组均显著低于对照组 (P <0 0 1)。 (2 )两组病人血浆粘度和纤维蛋白原麻醉后 1h及术毕时均显著降低 (P <0 0 5 ) ;术后 4 8h ,PCEA组恢复至术前水平 ;而对照组仍升高 (P <0 0 5 ) ,并显著高于PCEA组 (P <0 0 5 )。两组病人全血粘度各切变率麻醉后 1h及术毕各值均下降 ,PCEA组术后 2 4、4 8h各值逐渐恢复至麻醉前水平 ,而对照组则进行性升高 ,术后 4 8h显著高于麻醉前水平 (P <0 0 1) ,与PCEA组比较有显著性差异 (P <0 0 1)。结论 PCEA改善了全髋置换术患者术后血液流变学指标 ,可作为减少术后血栓性并发症的有效措施之一。
Objective To investigate the effect of postoperative patient controlled epidural analgesia(PCEA) on the hemorheology after total hip replacement surgery.Methods Twenty six patients,ASAⅠ-Ⅱ,undergoing total hip replacement operation were randomly divided equally into two groups and all received epidural anesthesia.2 ml/h of the mixture of 0.05 mg/ml morphine,1.25 mg/ml bupivacaine and 0.025 mg/ml droperidol was administered in PCEA group.PCA Setting: Loding dose of 0.5 mg morphine, bolus dose of 0.5 ml,and lock-out time of 15 min.Pethedine was administered intramuscularly according to pain in control group.Results (1)VAS scores of the pain in PCEA group were lower than those in control group(P<0.01).(2)The plasma viscocity, fibrinogen and blood viscocity were significantly lower 1 h after anesthesia and at the end of surgery than those before anesthesia(P<0.05),which in control group were higher than those in PCEA group 48 h after operation.Conclusion The hemorheology is improved by PCEA with less side effect of thrombolism.
出处
《临床麻醉学杂志》
CAS
CSCD
2003年第12期731-733,共3页
Journal of Clinical Anesthesiology
