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目的 观察右美托咪定复合舒芬太尼静脉患者自控镇痛(PCA)对不同血管紧张素转换酶(ACE)基因型高血压患者术后应激反应的影响.方法 采用PCR法检测手术患者的高血压ACE基因型,分别选择DD型(A组)、DI型(B组)和Ⅱ型(C组)患者各30例,术后采用右美托咪定复合舒芬太尼行静脉PCA.镇痛药物配方为右美托咪定3.0 μg/kg+舒芬太尼1.5 μg/kg+格拉司琼100μg/kg,加生理盐水稀释至100ml.PCA设置:背景输注速率2ml/h,PCA剂量0.5ml,锁定时间15 min.评定镇痛效果,记录围术期循环变化,测定血糖和血浆皮质醇浓度.结果 三组术后VAS疼痛评分均较满意;术后4、8、16和24 h,三组的心血管反应(血压、HR和HR-SBP乘积)、血糖和皮质醇浓度差异均无统计学意义(P＞0.05).结论 右美托咪定复合舒芬太尼静脉PCA可有效抑制DD、DI和Ⅱ型ACE基因型高血压患者术后应激反应.“,”Objective To observe the effect of intravenous patient-controlled analgesia(PCA) with combined use of dexmedetomidine and sufentanil on the stress response to surgery in hypertensive patients of different angiotension converting enzyme (ACE) genotypes.Methods The ACE genotypes were identified by RFLP-PCR in surgical patients.Intravenous PCA with combined use of dexmedetomidine and sufentanil was performed in the hypertensive patients with ACE genotypes of DD(group A,30 cases),DI(group B,30 cases),or Ⅱ(group C,30 cases).The analgesic solution consisted of dexrnedetomidine 3.0 μg/kg,sufentanil 1.5 μg/kg and granisetron 100 μg/kg in 100 ml of normal saline.PCA variables were set up as a background infusion of 2 ml/h and a bolus dose of 0.5 ml in a lockout interval of 15 minutes.The HR,SBP and DBP were recorded before and in the 4th,8th,16th and 24th hour after operation and product of HR and SBP(RPP) was calculated.Analgesia was evaluated by VAS pain scoring and blood glucose and plasma cortisol were detected as well.Results Analgesia effects of three groups were all satisfactory.There were no significantly differences in HR,SBP,DBP,RPP,blood glucose and plasma cortisol among three groups during analgesia(P＞0.05).Conclusion Intravenous PCA with combined use of dexmedetomidine and sufentanil can effectively inhibit the stress response to surgery in hypertensive patients with the ACE genotypes of DD,DI or Ⅱ.