GEA对老年冠心病患者非心脏手术围术期心血管保护

The Effect of GEA on Protection of Cardiac Vessels during Perioperative Period in Patients with CHD to Perform Upper Abdominal Operation

目的探讨高胸段硬膜外阻滞复合全身麻醉在老年冠心病患者上腹部手术时对心血管保护方面的临床应用价值。方法将60例心功能I^II级,择期行上腹部手术的老年冠心病患者随机分成两组,单纯全麻组(GA组)和硬膜外复合全麻组(GEA组),监测患者围术期血流动力学变化,并运用放射免疫平衡法检测围术期血清IL-6、TNF-α及皮质醇水平。结果围术期血清IL-6、TNF-α及皮质醇水平均有升高,GA组升高更明显,各时段与GEA组比较,差异显著(P<0.05)。结论全麻联合高位硬膜外阻滞在保持围术期血液动力学的相对稳定,减少手术应激反应的同时对细胞因子起到了一定的调控作用,减少围术期心血管并发症优于单纯全麻。

Objective To study the effect of general anesthesia combined with epidural anesthesia（GEA） on the protection of cardiac vessels in old patients with coronary artery disease to perform upper abdominal surgery during the perioperative period. Methods Sixty old patients with coronary heart disease scheduled for upper abdominal surgery were randomly allocated into one of the two groups： GEA group and GA group. Blood samples were taken during peri-operation time. IL-6, TNF-α and cortisol were detected with radio-immunoassay. Results In both two groups, IL-6 concentration began to increase after intubation. It reached the peak level at 2 hour after operation and returned to the pre-operative level in the morning of the second postoperative day. But at every time of test after intubation, the concentration of IL-6 in GA group was higher than that of GEA group with a significant difference （P〈0.01）. The concentrations of TNF-α and cortisol were similar to the trend of IL-6. Conclusion The balance of cytokines are affected by stimulations from anesthesia and surgical operation. General anesthesia combined with epidural anesthesia can keep stabilization of hemodynamic changes, lowing stress response and at the same time regulating the cytokines＇ level, thus reducing the cardiovascular complications of those old people.