不同麻醉方法对非体外循环冠状动脉搭桥术患者血管活性肽的影响

Effect of Three Anesthetic Methods on Level of Peptides Endothelin and Angiotens in Ⅱin the Patients Undergoing OPCAB Grafting

目的:研究不同麻醉方法与OPCAB围术期内皮素-1(ET-1)、血管紧张素Ⅱ(AngⅡ)的变化及其与临床多种有关指标的关系,以指导临床上选择合适的麻醉方法。方法:62例冠心病行OPCAB病人随机分为两组:A组,全身麻醉组;B组,全身麻醉复合高位硬膜外麻醉组。每组31例。观察每组病人术后一周内围术期心衰、围术期心梗、围术期心率失常、使用IABP、肺脏及其他重要脏器并发症的发生率,测定术前(T1)、术终(T2)、术后24h(T3)血浆ET-1、AngⅡ水平。结果:术后围术期心衰、心梗、心率失常、使用IABP、肺脏及其他重要脏器并发症的发生率B组较A组小,但差别无统计学意义(P>0.05);两组病人血浆内的ET-1和AngⅡ浓度在T2和T3时均明显较T1时间增高(P<0.05),但T2和T3之间的比较差别无显著性(P>0.05);同一时间点的组间比较:在T2时和T3时B组病人的血浆ET-1和AngⅡ浓度均明显较A组的低(P<0.05)。结论:全身麻醉复合高位硬膜外麻醉比单用全身麻醉方法更适用于OPCAB术中。

Objective： To investigate the effects of three anesthetic methods on level of Peptides Endothelin-1 （ ET-1 ） and Angeotensin Ⅱ （ Ang Ⅱ ） in patients undergoing off-pump coronary bypass grafting （OPCAB）. Methods： 62 patients undergoing OPCAB were separated into two groups： patients in group A were anesthetized by general anesthesia and group B in combination of thoracic epidural anesthesia and general anesthesia. To all patients, the level of ET-1 and Ang Ⅱ of plasma before operation （T1）, at the end of operation （T2） and 24h （T3） were detected and operating outcomes were observed. Result： There were no significantly differences in operating outcomes among two groups. In two groups, the level of ET-1 and Ang Ⅱ in T2 , T3 were higher than that in T1 Compared to group B. Conclusions： In patients undergoing OPCAB, combination of thoracic epidural anesthesia can more effectively suppress the increase of plasma ET-1 and Ang Ⅱ level than general anesthesia, providing better heart protection during operation.