静脉普鲁卡因麻醉下TEA对心肌缺血犬血流动力学和血浆NO的影响

EFFECT OF THORACIC EPIDURAL ANESTHESIA COMBINED WITH INTRAVENOUS PROCAINE COMPOUND ANESTHESIS ON HEMODYNAMICS AND PLASMA NO DURING MYOCARDIAL ISCHEMIA IN DOGS

研究静脉普鲁卡因麻醉下胸段硬膜外麻醉（TEA）对心肌缺血犬血流动力学、血浆一氧化氮（NO）、乙酰胆碱（Ach）及脂质过氧化物（LPO）的影响，以此评价TEA加静脉普鲁卡因全身麻醉在缺血性心脏病麻醉中的应用价值。10只犬行胸7-8硬膜外穿刺置管及复制成左冠状动脉前降支（LAD）狭窄模型后，随机分成两组。对照组（n＝5）静滴1％普鲁卡因，硬膜外腔注射生理盐水2ml；实验组（n=5）静滴1％普鲁卡因，硬膜外腔注射0．5％布比卡因2ml。结果显示，对照组麻醉后血流动力学无明显变化，血Ach高于LAD狭窄前（p＜0．05）；实验组心率（HR）、平均动脉压（MAP）、左室每搏功指数（LVSWI）以及心肌耗氧指数（MOCI）下降（P＜0．05或0．01），血Ach高于LAD狭窄前及LAD狭窄后麻醉前水平（P＜0．05）。两组血浆NO、LPO无明显变化。提示静脉普鲁卡因麻醉下TEA可降低缺血心肌氧耗、改善冠脉循环、稳定血管内皮细胞功能，是缺血性心脏病可取的麻醉方法。

To determine the potential clinical value of thoracic epidural anesthesia(TEA) combined with intravenous procaine compound anesthesia(PCA) during myocardial ischemia, 10dogs modeled direct left ventricular coronary artery(LAD)narrow were randomly divided bo groups.2ml of NS(Group A,n=5) or 0. 5% bupivercaine (Group B, n = 5) was injected into the T7 - 8 epidural space during 1% procaine compound solution i, v. Effect of two groups on hemodynamics, glasma nitric oxide (No), acetylcholine(Ach), lipid peroxide(LPO)were studied. The resulted showed that the level of plasma Ach was higher than that before LAD norrow(P<0.05)in group A (control group); the HR, MAP,, LVSWI and MOCI were decreased during anesthesia, and the levd of plasma Ach was higher than that before or after LAD narrow(P<0.05) in group B. But the changes of plasma NO and LPO were no significant in group A and group B. It is suggested the TEA plus PCA may reduce myocardial O2 consumption, improving coronary circulation and stabilize the function of vascular endothelium.Thus TEA combined with PCA may be beneficial on patients with coronary artery desease.