胸段硬膜外阻滞麻醉改善手术后心肌缺血的临床研究  

Clinical effect of thoracic epidural block in reducing postoperative myocardial ischemia

作　　者：李朝标[1] 李劲松[1] 虎良艳[1] 陆兴恒[1] 陈锦[1] 

机构地区：[1]云南省文山州人民医院,云南文山663000

出　　处：《心血管病防治知识（学术版）》2013年第2期36-38,共3页Prevention and Treatment of Cardiovascular Disease

摘　　要：目的研究分析胸段硬膜外阻滞麻醉对改善手术后心肌缺血的临床效果。方法选取2010年6月-2012年6月收治的行择期开胸手术的120例患者,分为观察组(60例)和对照组(60例)。分别采用胸段硬膜外阻滞麻醉复合复合全麻麻醉方式和单纯全麻麻醉方式,比较两组患者手术中生命体征基本变化情况,以及术后心肌缺血整体改善情况。结果在DBP、SBP、HR几项指标上,麻醉后,观察组几项指标在插管前均出现下降,但在手术开始后逐步恢复,至拔管后各指标水平与麻醉前差异性不明显(P>0.05);对照组麻醉后在几项指标上持续出现降低,拔管后几项指标的检测值较麻醉前均具有比较明显的差异(P<0.05);观察组麻醉后RPP值维持在12000水平之上,对照组一直在12000之下。术后心电图的改善情况上,观察组的S-T波与T波改善效果更为明显;另外,观察组术后心肌缺血改善总有效率为85.2%,对照组为65.0%。观察组整体改善效果更佳(P<0.05)。结论胸段硬膜外阻滞复合全麻方法在改善手术后心肌缺血中效果比较明显,值得临床推广应用。Objective To investigate the clinical effect of thoracic epidural block in reducing postoperative myocardial ischemia. Methods A total of 120 patients, who were admitted to our hospital for scheduled thoracotomy from June 2010 to June 2012, were divided into observation group （n = 60） and control group （n = 60）. The observation group underwent thoracic epidural block combined with general anesthesia, while the control group underwent general anesthesia alone. The two groups were compared in terms of basic changes in vital signs during operation and improvement in postoperative myocardial ischemia. Results In the observation group, the diastolic blood pressure （DBP）, systolic blood pressure （SBP）, and heart rate （HR） dropped before intubation, but rose gradually after the operation began, and they were not significantly different from the values before anesthesia after extubation （P〉0.05）. In the control group, the DBP, SBP, and HR decreased continuously and were significantly different from the values before anesthesia after extubation （P〈0.05）. After anesthesia, the rate pressure product remained above 12000 in the observation group but below 12000 in the control group. Compared with the control group, the observation group showed significantly more improvements in S-T segment and T wave. Only 65.0% of the control group showed improvement in postoperative myocardial ischemia, versus 85.2% of the observation group （P〈 0.05）. Conclusion Thoracic epidural block combined with general anesthesia are effective in reducing postoperative myocardial ischemia and show promise for clinical application.

关 键 词：硬膜外 麻醉 心肌缺血 研究 

分 类 号：R614[医药卫生—麻醉学]