丙泊酚靶控输注复合硬膜外麻醉对老年高血压患者心肌酶及心肌肌钙蛋白的影响  

Effects of combined propofol target controlled infusion with epidural anesthesia on perioperative myocardial enzymes and serum troponin-I in eldly patients with hypertension

作　　者：赵建英[1] 林财珠[1] 

机构地区：[1]福建医科大学附属第一医院麻醉科,350006

出　　处：《临床麻醉学杂志》2010年第10期869-871,共3页Journal of Clinical Anesthesiology

基　　金：福建省自然科学基金项目(2008J0287;X08050043)

摘　　要：目的观察丙泊酚靶控输注(TCI)复合硬膜外麻醉对老年高血压患者围术期心肌酶及心肌肌钙蛋白(cTnI)的影响。方法择期上腹部手术老年高血压患者60例,ASAⅡ或Ⅲ级。随机均分为两组:丙泊酚TCI组(Ⅰ组)与丙泊酚TCI复合硬膜外麻醉组(Ⅱ组)。记录麻醉前(T0)、拔除气管导管后即刻(T1)、术后6h(T2)、24h(T3)、48h(T4)的BP、HR,并采血检测血清肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、谷草转氨酶(AST)及cTnI的浓度。结果与Ⅰ组比较,T2～T4时Ⅱ组SBP和DBP明显降低(P<0.01);与Ⅰ组比较,T1、T3时Ⅱ组cTnI,T2时CK-MB,T3、T4时CK均明显降低(P<0.01)。结论与单纯丙泊酚TCI麻醉比较,丙泊酚TCI复合硬膜外麻醉应用于老年高血压患者非心脏手术在一定程度上能够减轻患者围术期的心肌损害。Objective To investigate the effects of propofol target controlled infusion （TCI） with epidural anesthesia on perioperative myocardial enzymes and serum troponin Ⅰ in eldly with hypertension. Methods Forty ASA Ⅱ or Ⅲeldly patients undergoing for elective abdominal surgery were randomly divided into two groups （n=30 each）： group Ⅰ propofol TCI and group Ⅱ combined propofol TCI with epidural anesthesia. BP, HR, serum CK-MB, CK, LDH, AST and cTnI were recorded before anesthesia （T0）, immediately （T1）, 6 h （T2）, 24 h （T3） and 48 h （T4） after operation. Results SBP and DBP were significantly decrease in group Ⅱ at T2 ,T3 and T4 compared to group Ⅰ （P〈0.01）. Serum cTnI at T1and T3, CK-MB at To, CK at T3and T4 were significantly decrease in group Ⅱ that compared to group Ⅰ （P〈0. 01）. Conclusion Combined propofol TCI with epidural anesthesia in eldly patients with hypertension has a better protective effect on myocardial injury compared with propofol TCI anesthesia only.

关 键 词：硬膜外麻醉 丙泊酚 高血压 肌钙蛋白 

分 类 号：R614[医药卫生—麻醉学]