CAJ | 학술논문

目的　观察冠心病患者上腹部手术后硬膜外镇痛（Epidural, EP）对机体应激反应及心电图的影响. 方法　比较术后EP与肌注哌替啶（MI）的镇痛效果，检测围术期患者血清皮质醇、胰岛素、血糖和心电图的变化情况. 结果　①镇痛效果：EP组优于MI组[(1.56±0.53) vs ( 4.22±1.74), P<0.01]；②术后血清皮质醇、胰岛素和血糖浓度：EP患者明显低于MI患者(P<0.05)；③术后10和24 h ST段压低导联数和ST段压低值总和：EP组趋于减少，MI组则明显多于术前水平和EP组(P<0.05). 结论　冠心病患者上腹部手术后硬膜外镇痛明显减轻术后疼痛应激反应并减少心肌缺血的发生.
목적　관찰관심병환자상복부수술후경막외진통（Epidural, EP）대궤 체응격반응급심전도적영향. 방법　비교술후EP여기주고체정（MI）적진통효과，검측위술기환자혈청피질순、이도소、혈당화심전도 적변화정황. 결과　①진통효과：EP조우우MI조[(1.56±0.53) vs ( 4.22±1.74), P<0.01]；②술후혈청피 질순、이도소화혈당농도：EP환자명현저우MI환자(P<0.05)；③술후10화24 h ST단압저도련수화ST단압 저치총화：EP조추우감소，MI조칙명현다우술전수평화EP조(P<0.05). 결론　관심병환 자상복부수술후경막외진통명현감경술후동통응격반응병감소심기결혈적발생.
AIM　To compare the effects of postoperative epidura l single bolus bupivacaine analgesia (EP group) with intramuscular injection (MI group) of pethidine after upper abdominal oper ation on stress response and electrocardiogram in patients with coronary heart disease. METHODS　[ WTBZ Patients were followed up at 6, 10, 24 h after operation and the degree of pain, the change of ECG, the levels of cort isol, insulin and blood sugar were assessed. RESULTS　① Efficacy of pain relief in EP group was superior to that in MI group [(1.56±0.53) vs (4.22±1.74), P<0.01]; ② Levels of cortisol, insulin, blood sugar in MI grou p were markedly higher than those in EP group (P<0.05). ③ At postoperative 10 h and 24 h the sites of ST depression and total ST depression of 12 sites of ECG in MI group significantly increased as compared with preoper ative values and those of EP group (P<0.05). CONCLUSION　Postop erative epidural analgesia can markedly reduce the stress response and improve myocardial ischemia in patients with cor onary heart disease undergoing upper abdominal operation.