高位硬膜外阻滞对冠心病患者心率变异性影响的研究  

Clinical Value of High Epidural Block in Regulating Autonomic Nerve of Patients with Coronary Heart Disease

作　　者：屈军[1] 刘锦[1] 刘晖[1] 郑利民 黄绍农[3] 

机构地区：[1]广东医学院附属西乡人民医院麻醉科,广东省深圳市518102 [2]深圳市北大医院 [3]深圳市第二人民医院

出　　处：《中国全科医学》2010年第32期3628-3630,3634,共4页Chinese General Practice

基　　金：深圳市科技计划项目(200703116)

摘　　要：目的明确高位硬膜外阻滞对冠心患者的自主神经调节作用及治疗意义。方法选择ASA分级Ⅱ～Ⅳ级冠心患者60例,随机分成两组,每组30例:A组为对照组,行常规内科治疗;B组患者选取胸4～5硬膜外间隙穿刺置管,用药为0.8%利多卡因,控制麻醉平面在胸1～5,以微量注射泵输注0.8%利多卡因约2～3ml/h,持续5d,给药后30min、12h、1d、3d、5d观察患者的血压(收缩压、舒张压)及心率的变化,同时记录心率变异性的低频(LF)、高频(HF)及低高比值(LF/HF)。结果阻滞后,治疗组较对照组的血压(收缩压、舒张压)和心率得到明显改善(P<0.05),患者LF、HF、LF/HF均降低,与对照组比较差异有统计学意义(P<0.05);LF降低程度显著大于HF的降低程度,LF/HF亦明显降低(P<0.05);在12h与3d时间点,对照组与实验组LF/HF比较差异有统计学意义(P<0.05)。结论高位硬膜外阻滞可相对提高迷走神经的张力,局限性、可逆性地阻滞T1～5支配心脏的交感神经传入和传出纤维,引起冠状血管扩张,由此改善缺血区的血供和氧供,对于冠心病临床治疗具有可行性。Objective To investigate the clinical value of high epidural block（HEB）in regulating the autonomic nerve of patients with coronary heart disease（CHD）.Methods A total of 60 patients with ASAⅡ～Ⅳ CHD were equally and randomly divide into two groups：control group,applied with general medical therapy;HEB group,0.8% lidocaine was appled between T1 ~ T5 at a rate of 2~ 3 ml/h for 5 days.Systolic pressure,diastolic,and heart rate were recorded 30 min,12 h,1d,3 d,and 5 d after administration.For heart rate variability（HRV）,the low frequency（LF）,high frequency（HF）,and their ratio（LF/HF）were also recorded.Results After epidural block,blood pressure（systolic pressure and diastolic pressure）was significantly improved in the HEB group compared with control group（P〈0.05）;the LF,HF,and LF/HF also decreased and were significantly superior to those in control group（all P〈0.05）.The extent of the decrease in LF was significantly larger than that in HF,and LF/HF also significnatly decrease（P〈0.05）.The LF/HF was also significantly different between HEB group and control group（P〈0.05）.Conclusion High epidura block can enhance the strain of pneumogastric nerve,block hocus T1 -T5 sympathetic nerve afferent fibers and centrifugal fiber in a localized and reversible way,and thus lead to a dilatation of vasa coronaria.Therefore,it can improve the blood supply and oxygen supply in ischemic region and therefore is feasible to be applied in clinical practice.

关 键 词：麻醉 硬膜外 心率变异性 冠心病 

分 类 号：R614[医药卫生—麻醉学]