摘要
目的观察不同镇痛方式对肾移植患者术后镇痛效果及肾功能的影响。方法选择同种异体肾移植手术患者60例,采用硬膜外复合全身麻醉完成手术,术后随机分为硬膜外自控镇痛组(A组,n=20)、静脉自控镇痛组(B组,n=20)和间断肌注镇痛组(C组,n=20)。3组分别于麻醉前,手术后24、48、72h抽取静脉血测定内皮素、尿素氮及肌酐。观察记录术后2、6、12、24、48h的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、视觉模拟评分法(VSA)评分及Ramsay评分等指标。结果 A、B组患者术后6、12、24hVAS评分较C组明显降低(P<0.01)。3组患者术后24h内皮素、尿素氮及肌酐含量均下降,与麻醉前比较差异有统计学意义(P<0.01),且A组内皮素、尿素氮、肌酐在术后各时间点较B、C组下降更明显,差异有统计学意义(P<0.05)。结论自控镇痛用于肾移植术后效果确切。硬膜外自控镇痛能更有效减轻疼痛刺激导致的应激反应,有利于移植肾功能的恢复。
Objective To observe the influence of different analgesia on the analgesic effects and renal function in patients after kidney transplantation.Methods Sixty patients received kidney transplant operation under epidural block combined with general anesthesia were randomly divided into three groups（n=20）,patient controlled epidural analgesia（PCEA） group（group A）,patient controlled intravenous analgesia（PCIA）group（group B） and analgesic drug intravenous injection according to the need of patients group（group C）.The contents of the plasma endothelin,urea nitrogen and creatinine were determined before anesthesia or at the time of 24,48,72 h after the operation.Heart rate（HR）,mean arterial pressure（MAP）,pulse oxygen saturation（SpO2）,scale of VAS and Ramsay were recorded at 2,6,12,24 and 48 h after operation.Results Scale of VAS decreased significantly at 6,12,24 h after the operation in group A and B than those at the same time in group C（P〈0.01）.The plasma endothelin,urea nitrogen and creatinine obviously decreased after operation than before anesthesia in 3 group（P〈0.01）.The plasma endothelin,urea nitrogen and creatinine decreased significantly after operation in group A than those at the same time in group B and C（P〈0.05）.Conclusion Patient-control analgesia provides sufficient analgesia.PCEA can mostly lessen stress reaction induced by pain,improve renal function in the patients with kidney transplantation.
出处
《重庆医学》
CAS
CSCD
北大核心
2011年第32期3249-3251,共3页
Chongqing medicine
关键词
镇痛
肾移植
内皮素
肾功能
analgesia
kidney transplantation
endothelin
kidney function
