高胸段硬膜外阻滞对脱泵冠状动脉旁路手术患者的影响  

Effects of thoracic epidural analgesia for release of troponin T in patients undergoing off-pump coronary artery bypass surgery

作　　者：李懿[1] 陈智[1] 缪长虹[1] 薛张纲[1] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海200032

出　　处：《上海医学》2005年第11期932-934,共3页Shanghai Medical Journal

摘　　要：目的比较单纯全身麻醉和全麻复合高胸段硬膜外阻滞(TEA)对脱泵冠状动脉旁路手术(OP-CAB)围术期肌钙蛋白T(TnT)释放水平的影响.方法 40例年龄＜65岁、射血分数(EF)＞50%、纽约心脏协会(NYHA)心功能分级Ⅰ～Ⅱ级并计划进行OPCAB手术的男性患者随机均分为两组.TEA组术中采用TEA复合全身麻醉,术后采用硬膜外镇痛;GA组仅采用单纯全身麻醉.观察两组围术期TnT释放水平.结果 GA组手术结束时及术后3 h TnT水平均较术前明显升高,TEA组则无变化.两组TnT水平在术后24 h达高峰,并在术后48 h呈下降趋势.结论全身麻醉复合TEA减少OPCAB手术患者心肌TnT的释放,有利其预后.Objective To compare the effects of simple general anesthesia （GA） and GA combined with thoracic epidural analgesia （TEA） on hormonal effects in patients undergoing off-pump coronary artery bypass surgery. Methods Forty male patients undergoing off-pump coronary artery bypass surgery were randomized into 2 groups. Perioperative and postopeative TEA with bupivacaine 0. 375% plus fentanyl （2 μg/ml） combined with GA in 20 patients as one group, and 20 patients receiving GA alone served as the control group. Results A significant increase of troponin T was found in GA group from the end of surgery up to 3 h but no obvious change shown in TEA group; and reached a peak value 24 h after surgery in both groups. A decrease tendency appeared 48 h postoperatively. Conclusions Less release of troponin T may decrease myocardial ischemia is found in patients under GA combined with TEA.

关 键 词：胸段硬膜外阻滞 脱泵冠状动脉旁路手术 肌钙蛋白T 

分 类 号：R614[医药卫生—麻醉学]