上胸段硬膜外阻滞对冠心病患者心肌氧耗和缺血的影响

The influence of the upper thoracic block on the consumed oxygen and ischemia in the coronary disease of elderly patients

目的 观察上胸段硬膜外阻滞对冠心病患者开胸手术心肌氧耗和缺血的影响。方法选择50例合并冠心病开胸肺叶切除术患者，ASAⅡ-Ⅲ级，随机分为全身麻醉组（CA组）和上胸段硬膜外阻滞加全身麻醉组（GEA组），每组各25例。术中以HP多功能监测系统连续监测无创血压、SaO2和HR变化，于麻醉前、硬膜外注药后20min、麻醉诱导气管插管完毕即刻、术毕、拔管完毕即刻、拔管后30min，记录收缩压（SBP）、HR及两者乘积（RPP），应用ST—T自动分析监测系统监测ST段及T波变化。结果 GA组在麻醉诱导气管插管完毕即刻、拔管完毕即刻、拔管后30min，SBP、HR、RPP均有升高，两组比较差异有统计学意义（P〈0．05）；GEA组在硬膜外注药后20min及其以后各时间点ST段及T波有显著性改善（P〈0．05）。结论 上胸段硬膜外阻滞应用于冠心病患者开胸手术能降低心肌氧耗，改善心肌缺血，有助于降低围手术期冠心病患者的并发症。

Objective To evaluate the upper thoracic block on the consumed oxygen and ischemia in the coronary disease of elderly patients. Methods Fifty ASA Ⅱ -Ⅲ patients of the coronary disease undergoing lobectomy were randomized to receive either combined general-epidural anesthesia （GEA group, n=25 ） or general anesthesia （GA group, n=25 ）.To observe systolic pressure （SBP）, heart rate （HR）, ST section and T wave before anesthesia（T,）, after epidural infusion 20 minutes（T,）, intubated the trachea（T3）, at the end of operation（T4）,drew the trachea（T5） ,after drew the trachea 30 minutes （T6）. Results SBP, HR, RPP were significantly increased in GA group as compared with those in GEA group at T3, T5,T6 （P 〈 0.05 ）, The change of ST section and T wave were significantly improved in GEA group as compared with those in GA group at T2, T3, T4,T5,T6 （P〈 0.05）. Conclusion The influence of the upper thoracic block can decrease the consumed oxygen and ischemia, improve the myocardial ischemia in the coronary disease patient undergoing lobectomy, to reduce the complication of the coronary disease patient in the perioperative.