高胸段硬膜外阻滞对合并冠心病患者上腹部手术的应用研究  

Study on high thoracic epidural block for patients with coronary heart disease undergoing upper abdominal surgery

作　　者：汪飞翔 张林珍 方复 

机构地区：[1]浙江省桐庐县第一人民医院麻醉科,311500 [2]浙江省桐庐县第一人民医院ICU,311500 [3]浙江省桐庐县第一人民医院外科,311500

出　　处：《中国医师进修杂志》2008年第5期12-15,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的观察行上腹部手术的冠心病患者围手术期高胸段硬膜外阻滞防止心肌缺血的效果。方法对20例择期行上腹部手术的冠心病患者，随机分为两组，每组各10例。治疗组予以高胸段硬膜外阻滞联合全身麻醉的方法，术毕予经硬膜外镇痛泵镇痛，观察其围手术期血流动力学指标，ECG变化，血清肌钙蛋白Ⅰ、肌红蛋白、肌酸磷酸激酶同工酶（CPK-MB）定性变化和采用视觉模拟评分法评估术后镇痛效果。并与采用单纯全身麻醉的方法，术后予经静脉镇痛泵镇痛的对照组进行比较。结果治疗组比对照组血流动力学指标更平稳（P〈0．05）；对照组ECG示sT段压低幅度的总和在术毕拔管时和术后10h时增加明显且高于治疗组同时间点（P〈0．05）；对照组术后10、24h时肌钙蛋白Ⅰ阳性和术后24hCPK—MB阳性率要明显高于治疗组同时间点（P〈0．05）；治疗组术后镇痛效果要优于对照组（P〈0．05）。结论高胸段硬膜外阻滞联合全身麻醉可以减少行上腹部手术的冠心病患者围手术期心病肌缺血性损伤的发生。Objective To observe the effect of high thoracic epidural block（HTEB） for preventing myocardial ischemia （MI） in patients with coronary heart disease undergoing upper abdominal surgery. Methods Twenty patients undergoing upper abdominal surgery were randomly divided into two groups： M group （treated with HTEB, 10 patients）was given both general anesthesia and HTEB and patient controlled epidural analgesia （PCEA） after operation and C group （without HTEB, 10 patients）was given only general anesthesia and patient controlled intravenous analgesia （PCIA） after operation. The hemodynamics, ECG changes and serum troponin I and myoglobin and creatine-kinase isozyme, the analgesia efficacy in M group were compared with those in C group. Results The hemodynamics in M group was more stable than that in C group （P 〈 0.05 ）.Compared with M group, the total number of ST-segment depression at tracheal extubation moment and 10 hours after operation were significantly increased in C group （P 〈 0.05）. The positive rates of serum troponin I and creatine-kinase isozyme at 10 hours and 24 hours after operation in C group were much higher than those in M group （P 〈 0.05 ）. The analgesia effect in M group was superior to that in C group （P 〈 0.05） Conclusion The HTEB combined with general anesthesia may reduce myocardial ischemia in patients with coronary heart disease undergoing upper abdominal surgery.

关 键 词：麻醉 硬膜外 冠状动脉疾病 心肌缺血 手术 上腹部 

分 类 号：R614[医药卫生—麻醉学]