全麻复合硬膜外阻滞对老年开胸手术患者围手术期心肌酶及心肌肌钙蛋白T的影响

The effects of combined general-epidural anaesthesia on perioperative myocardial enzymogram and troponin T of the myocardium in old patients undergoing thoracic surgery

目的 研究硬膜外阻滞复合全麻对老年开胸手术患者围手术期心肌酶及心肌肌钙蛋白T（cTnT）的影响。方法 选择择期老年开胸手术病人38例，ASAⅠ～Ⅱ级，随机分为全麻组（G组）与硬膜外复合全麻组（C组）。于麻醉前、术毕、术后6h、24h、48h采血检查血清肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、谷草转氨酶（AST）、乳酸脱氢酶（LDH）及cTnT的浓度。结果 两组镇痛效果差异无统计学意义。G组CK、AST、LDH在术毕及术后均明显高于麻醉前（P〈0．05），cTnT在术后显著高于麻醉前（P〈0．01）。C组除CK在术毕24h高于麻醉前外（P〈0．01），其他指标差异均无统计学意义（P〉0．05）；C组的CK、AST在术毕及术后6h显著低于G组（P〈0．05），LDH在术后6h显著低于G组（P〈0．05）．而cTnT在术后6h、24h及48h均显著低于G组（P〈0．05）。结论 硬膜外复合全麻比单纯全麻更能减少患者围手术期心肌的损害。

Objective To observe the effects of combined general - epidural anesthesia on perioperative myocardial enzymogram rind troponin T of the myocardium （eTnT）in old patients undergoing thoracic surgery. Methods Thirty- eight ASA Ⅰ - Ⅱ patients aged 60～80 years old were randomly divided into two groups. General anesthesia group （group G） ： anesthesia was induced with fentanly, propofol and vecuronium and maintained with isoflurane, propofol and vecuronium. Combined anesthesia group（group C）- general anesthesia was perforated as in group G and continuous epidural block with l. 6% lidocaine was added during operation. Peripheral blood CK,CK - MB,AST, LDH and cTnT were measured before anesthesia , at the end of operation and at 6, 24, 48 hours after operation. Results Two groups could provide same postoperative analgesia. There was no change for HR, RR and MAP in two groups. Serum CK, AST, LDH and cTnT concentration in group G after operation were significantly higher than those before anesthesia （P〈0.05）. In group G, serum ASK at the 24th hour after operation and cTnT concentration after operation were obviously higher than those before anesthesia （P 〈0.05）. Serum CK, AST, LDH and eTnT concentration in group G were higher than those in group C after operation（P 〈 0.05）. Conclusion Epidural block combined with general anesthesia has a better protective effect on myocardial injury induced by operation.