胸段硬膜外阻滞复合全麻减轻老年高血压病患者围术期心肌损伤  

The protective effects of thoracic epidural block combined with general anesthesia on myocardial damage in elderly patients with hypertension undergoing thoracic surgery

作　　者：高玉福 张和国 徐志华 许永 朱国民 

机构地区：[1]南京市高淳人民医院麻醉科,211300

出　　处：《临床麻醉学杂志》2013年第10期983-985,共3页Journal of Clinical Anesthesiology

基　　金：南京市医学科技发展项目(2011-YKK11192)

摘　　要：目的探讨胸科手术中硬膜外阻滞复合全麻对老年高血压病患者心肌损伤的影响。方法择期行胸科手术患者40例，年龄≥65岁，ASAⅢ级，随机均分为胸段硬膜外阻滞复合全麻组（GEA组）和全麻组（GA组）。硬膜外穿刺确认进入硬膜外腔后，GEA组给予1．5％氯普鲁卡因5ml／h，GA组给予等量生理盐水。常规全麻诱导和维持，维持BIS值在40-60。记录麻醉前、气管插管后、手术探查后和拔除气管导管后即刻的ST段水平。记录麻醉前（T0）、手术开始后1h（T1）、术毕（T2）和术毕6h（T3）时的SBP、DBP和HR，并于T0～T3时测定血浆中心肌肌钙蛋白（cTnI）、C反应蛋白（CRP）和可溶性细胞间黏附分子（sICAM-1）浓度。结果与GA组比较，T2、L时GEA组的SBP和DBP明显下降，HR明显减慢（P〈0．05）。与麻醉前比较，两组在气管插管后、手术探查后和拔除气管导管即刻ST段明显压低（P〈0．05）。与GA组比较，GEA组在手术探查后和拔除气管导管即刻ST段压低程度明显减小（P〈0．05），GEA组L时CRP浓度明显升高，T2、瓦时cTnI浓度明显降低（P〈0．05）。结论胸段硬膜外阻滞复合全麻使老年高血压患者胸科手术术中CRP和cTnI浓度上升幅度明显下降，有利于减轻心肌受损程度。Objective To study the effects of thoracic epidural block combined with general anesthesia （GEA）with simple general anesthesia （GA）on myocardial damage in elderly patients with hypertension undergoing thoracic surgery. Methods Forty elderly patients with hypertension undergoing selective thoracic surgery, aged over 65 years old, ASAⅢ, were randomly divided into two groups, group GEA and group GA, 20 cases in each. After the epidural block was made sure to be effective, the patients assigned to group GEA received 1.5% 2-chloroprocaine （5 ml/h） before general anesthesia, and 0. 9% NaCl （5 ml/h）in group GA. General anesthesia was maintained with BIS at 40-60. The ST segment level were recorded in proceeding anesthesia, following intubating, operating and extubating. SBP,DBP and HR were recorded before operation（T0）, 1 h after operation （T1）, at the end of operation（T2 ）, 6 h after operation（T3 ）, and artery blood samples were taken at T0- T3 for determination of sICAM-1, CRP and cTnl using ELISA method. Results Compared with group GA, SBP, DBP and HR in group GEA were decreased at T2 and T3 （P〈0. 05）. Compared with proceeding anesthesia, the levels of ST segment depression in both group were significantly increased at following intubating, operating and extubating（P〈0.05）, the degree in group GEA were less than those in group GA at operating and extubating（P〈0.05）, the contents of CRP at T3 were increased and cTnI at T2, T3 were decreased （P 〈 0.05）. Conclusion For elderly patients with hypertension undergoing thoracic surgery, thoracic epidural block combined with general anesthesia can effectively suppress the increase in plasma CRP and cTnl, obviously improve myocardium damnification.

关 键 词：胸段硬膜外组滞 老年 高血压 心肌损害 心肌肌钙蛋白 

分 类 号：R614[医药卫生—麻醉学]