上胸段硬膜外阻滞对心绞痛患者自主神经的影响

Effects of high thoracic epidural anesthesiaon Sympathovgal in patients of angina pectoris

目的观察上胸段硬膜外阻滞对心绞痛患者自主神经的影响。方法选择内科治疗心绞痛(RAP)患者60例分为两组,A组(n=30)采用胸段硬膜外阻滞,胸椎3-4或胸椎4-5间隙穿刺,外接PCA镇痛泵。记录TEA治疗前及治疗后10分钟心率变异性(HRV)中的RR间期(RR)、最长RR间期(RRmax)、最短RR间期(RRmin)、全部正常RR间期标准差(SDNN)和相邻RR间期差值均方的平方根(rMSSD),评估TEA治疗对机体交感神经与副交感神经的平衡产生的影响。B组(n=30)采用内科药物治疗。结果A组患者在TEA治疗后RR、RRmax和RRmin明显延长,SDNN和rMSSD增加。B组在药物治疗后SDNN和rMSSD的值小于A组,提示药物治疗对心绞痛患者自主神经调节能力较A组患者差。结论上胸段硬膜外阻滞是治疗顽固性心绞痛的有效方法之一。

Objective To observe high thoracic epidural anesthesia for the influence of the patients Sympathovgal of angina pectoris. Methods 60 angina pectoris patients were Selected and randomly divided into two groups, patients of A group（n= 30） adopted high thoracic epidural anesthesia, chest vertebra 3 - 4 or 4 - 5 gap puncture, received PCA pump. FMonitored RR Interval（RR）, Maximal RR Interval （RRmax）, Minimal RR Interval（RRmin）, Standard Deviation in N- N Intervals（SDNN） and Root Mean Square of Successive Differences （rMSSD） of HRV before and after TEA treatment 10min, estimated TEA treatment may improve sympathovgal balance. Patients of B group（n = 30） treated with medication. Results After treated by TEA in A group patient, RR,RRmax and RRmin elongated cbviously, SDNN and increased. After treated with medication in B group, SDNN and rMSSD were less than A group. It was pointed out that B group which treated with medication adjusted sympathovgal worse than A group which treated by TEA. Conclusion TEA is one of the effective methods of treatment angina pectoris.