关键词: 镇痛;冠状动脉疾病;心电图;应激反应

    摘 要: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24h 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.

    Postoperative epidural analgesia reduces stress re┐sponse and improves myocardial ischemia in CHD patients

    CHEN Guo-Zhong，SUN Su-Qing，LI Xue，ZHOU A-Xing，ZHOU Song-Hua，ZHANG Rui Department of Anesthesiology，Affiliated Hospital，Jilin Military Medical College，Fourth Military Medical University，Jilin132013，China

    Keywords:electrocardiogram;stress response;coronary artery disease;analgesia

    Abstract:AIM To compare the effects of postoperative epidural single bolus bupivacaine analgesia(EP group)with intramuscular injection(MI group)of pethidine after upper abdominal operation on stress response and electrocardiogram in patients with coronary heart disease.METHODS Pa-tients were followed up at6 ......