全麻复合硬膜外阻滞对非体外循环冠状动脉旁路移植术应激反应的影响

Effects of thoracic epidural anesthesia combined with general anesthesia on the stress response in patients undergoing off-pump coronary artery bypass grafting

目的:研究不同麻醉方法对非体外循环冠状动脉旁路移植(OPCAB)患者围术期应激反应的影响,以指导临床上选择合适的麻醉方法。方法:60例冠心病行OPCAB的患者随机分为两组:对照组(单纯全身麻醉组);复合组(全身麻醉复合高位硬膜外麻醉组),每组30例。在手术前(T1)、术终(T2)和术后24 h(T3)检测血浆中内皮素-1(ET-1)、血管紧张素Ⅱ(AngⅡ)、白介素-6(IL-6)、IL-8、IL-10及肿瘤坏死因子(TNF-α)的含量。结果:两组血浆中ET-1,AngⅡ,IL-6,IL-8,IL-10及TNF-α水平在术前差异无统计学意义(P>0.05),但术终和术后24 h复合组明显低于对照组(P<0.05)。结论:高位胸段硬膜外阻滞复合全麻能显著降低OPCAB患者的应激反应,值得临床麻醉上推广应用。

Objective： To study the effects of two anesthetic methods on the stress response in patients undergoing off-pump coronary artery bypass grafting（OPCAB）.Methods： Sixty patients undergoing OPCAB were divided randomly into two groups.Patients in group A were anesthetized by general anesthesia and group B in combination of thoracic epidural anesthesia（TEA） and general anesthesia.To all patients,the levels of ET-1、AngⅡ、IL-6、IL-8、IL-10 and TNF-α of plasma before operation（T1）,at the end of operation（T2） and 24 h（T3）were defected. Results： The plasma levels of ET-1,AngⅡ,IL-6,IL-8,IL-10 and TNF-α were significantly lower in group B than those in group A（0.05）.But there were no significantly differences between two groups before operation. Conclusion： Compared with general anesthesia alone,TEA combined with general anesthesia can attenuate the stress response to surgery in the patients undergoing OPCAB and value to apply in the clinic anesthesia.