上胸段硬膜外阻滞和药物治疗对心绞痛患者的影响  

Influence of High thoracic Epidural Anesthesia and Medication on Patients with Angina Pectoris

作　　者：王涛[1] 孟尽海[2] 吴辉[3] 

机构地区：[1]银川市第一人民医院麻醉科,银川750001 [2]宁夏医学院附属医院麻醉科,银川750004 [3]宁夏医学院附属医院心内科,银川750004

出　　处：《宁夏医学院学报》2006年第6期487-489,共3页Journal of Ningxia Medical College

基　　金：银川市科技计划攻关项目(项目序号:05-1-58)

摘　　要：目的对比观察上胸段硬膜外阻滞(TEA)和药物治疗对顽固性心绞痛(RAP)患者血流动力学及Q-Td主要指标的影响。方法选择内科治疗RAP患者60例随机分为两组,A组(n=30)采用TEA,T3-4或T4-5间隙穿刺,外接患者自控镇痛泵(PCA),首次量为1%利多卡因5mL,阻滞平面T1-5;48h内持续恒速泵入0.125%布比卡因2mL/h维持。记录TEA治疗前、后的血压、心率、视觉模拟评分(VAS)和即时心电图等变化情况,计算心肌耗氧RPP指数,即二相乘积(D-P)。B组(n=30)常规给予硝酸酯类、钙通道阻滞剂、β受体阻滞剂及硝酸甘油治疗。结果A组患者经TEA治疗后收缩压和舒张压较B组明显下降(P<0.05),心率未见明显变化,D-P降低;A组患者Q-Td、校正的Q-T离散度(Q-Tcd),JT离散度(J-Td)和校正后的JT离散度(J-Tcd)较治疗前明显下降。结论上胸段硬膜外阻滞治疗顽固性心绞痛优于单纯药物治疗,是治疗顽固性心绞痛的有效方法之一。Objective To observe the influence of high thoracic epidural anesthesia and medical treatment on hemodynamic and heart function in patients with refractory angina pectoris. Methods 60 patients with angina pectoris were selected and randomly divided into two groups. A group （ n = 30） adopted high thoracic epidural anesthesia, chest vertebra 3 ～ 4 or 4 ～ 5 gap puncture, received PCA pump. First quantity： 5 mL of 1% lidocaine , blocked from T1-5; Maintain quantity： In 48 hours, pumped 0. 125 % bupivacaine with 2 mL/h constant speed. After 48 hours, patients took 5 mL of 1% lidocaine according to symptom. Before and after TEA treatment , standard ECG lead 12, blood pressure, HR, and visual simulate score were Continuously monitored and RPP index was calculated and the effects of TEA treatment were assessed. B group （ n = 30 ） were treated with medication. Results After treated by TEA , blood pressure in A group was lower than that in group B. Heart rate did not increase significantly, and D-P decreased markedly. Q-Td , Q-Tcd , J-Td and J-Tcd decreased significantly in group A. Conclusion TEA is one of the most effective methods in treatment of refractory angina pectoris.

关 键 词：上胸段硬膜外阻滞 血流动力学 Q—T离散度 

分 类 号：R614[医药卫生—麻醉学]