摘要
目的:观察术后疼痛应激与术后镇痛对患者血小板功能的影响。方法:40例择期腹部手术患者(ASAⅡ～Ⅲ级,年龄45～68岁),随机分为硬膜外镇痛组(E组)和对照组(C组),每组20例。E组采用全麻联合硬膜外阻滞+术后硬膜外镇痛,C组采用全麻+术后间断肌注哌替啶镇痛。分别于术后8、24、36、48、60、72h用视觉模拟评分法(VAS)评定疼痛程度;于术前及术后1、2、3、4、5d抽取外周静脉血测定血小板表面膜糖蛋白CD_(41)/CD_(61)、CD_(62p)和CD_(63)的表达量及血小板聚集率。结果:E组术后镇痛效果良好,术后8、24、36、48h的VAS评分显著低于C组(P<0.05,P<0.01)。与术前比较,两组术后第1天的血小板表面膜糖蛋白CD_(41)/CD_(61)、CD_(62p)和CD_(63)的表达量及血小板聚集率均有明显升高(P<0.05,P<0.01);与E组比较,C组术后1～4d血小板表面膜糖蛋白CD_(41)/CD_(61)、CD_(62p)和CD_(63)的表达量及血小板聚集率明显增加,两组之间差异显著(P<0.05,P<0.01)。结论:血小板聚集率与血小板表面膜糖蛋白的表达量呈正相关。术后疼痛应激可促进血小板活化及血小板聚集,增强血小板功能及血液凝集性,使机体处于相对高血凝状态;良好的术后镇痛有利于抑制机体的有害应激反应,降低血小板活性,减少血小板聚集,抑制血小板功能,降低血液凝集性,改善术后患者的高血凝状态,从而可作为减少术后血栓性并发症、提高手术患者康复质量的有效措施之一。
Objective：To observe the effect of postoperative pain stress and postoperative analgesia on the platelet function of postoperative patients. Methods：40 ASA Ⅱ-Ⅲ patients aged from 45 to 68 years old undergoing elective abdominal surgery were randomly divided into epidural analgesia group（group E, n = 20） and control group （group C, n = 20）. The patients in group E received the combined anesthesia of general anesthesia and epidural block plus postoperative epidural analgesia, and the patients in group C received general anesthesia plus postoperative intramuscular pethidine analgesia intermittently. VAS was used to assess pain intensity at the points of 8,24,36,48,60 and 72 h after surgery; blood samples were taken from peripheral vein before operation and on the 1^st , 2^nd , 3^th , 4^th and 5^th postoperative days for determination of the expression of CD41/CD〈 , CD62p and CD63 of the glycoprotein on the platelet membrane surface and the platelet aggregation rate. Results：The patients in group E achieved good postoperative analgesic results, VAS at 8,24,36 and 48 h after the operation in group E were markedly lower than that in group C（P〈0.05, P〈0.01 ）. Compared with the basic value before operation, the expression of CD41/ CD61 ,CD62p , CD63 and platelet aggregation rate in the two groups were significantly increased on the 1^st postoperative day（P〈0.05, P〈0.01 ） ; the expression of CD41/CD61 ,CD62p, ,CD63 and platelet aggregation rate in group C were all obviously higher than those in group E during the four postoperative days（P〈0.05, P〈0.01）. Conclusion：Platelet aggregation rate shows a positive correlation with the expression of the glycoprotein on the membrane surface of platelet. Postoperative pain stress can promote platelet activation and platelet aggregation, enhance platelet function and blood agglutination, and put the patient in a relative hypercoagulable status. A good postoperative analgesia can help to inhibit the vicious stress response of the body, low
出处
《中国临床医学》
北大核心
2007年第6期882-884,共3页
Chinese Journal of Clinical Medicine
基金
广东省深圳市科技局资助课题(编号200304051)
关键词
术后疼痛
应激
镇痛
血小板
功能
Postoperative pain
Stress
Analgesia
Platelet
Function
