单侧连续腰麻对股骨头置换术老年冠心病患者心肌损伤的研究

Study of Unilateral Continous Spinal Anesthesia Effecting Myocardial Injury Coronary Heart Disease in Elderly Patients Undergoing Hip Replacement

目的通过检测血液中心肌钙蛋白和心肌酶,评价单侧连续腰麻(UCSA)对行股骨头置换术的老年冠心病患者心肌损伤情况。方法选择行股骨头置换术老年冠心患者62例,年龄65～80岁,ASAⅡ级,随机分成UCSA组(Ⅰ组)和CEA组(Ⅱ组),每组31例。用针刺法测定阻滞范围及平面,监测记录麻醉前后各时点MAP、HR、SpO2变化及心电图ST段改变情况。在麻醉前、术后6h、术后第1天采集静脉血,测定心肌钙蛋白(ICTnI)、肌酸激酶(CK)及肌酸激酶同功酶(CK-MB)。结果Ⅰ组麻醉范围仅限于手术侧T10以下;与T0比较,Ⅰ组麻醉后各时点MAP、HR、SpO2无显著变化(P>0.05)。与Ⅰ组比较,Ⅱ组MAP在T3～6下降(P<0.05);CTnI在Ⅰ组处于低值≤(0.25±0.03)μg·L-1,组内不同时点无显著变化(P>0.05)。Ⅰ组CTnI阳性1例,Ⅱ组3例。两组与麻醉前比较,CK、CK-MB于术后6h、术后第1天升高(P<0.05)。结论UCSA镇痛完善,循环功能平稳,用于股骨头置换术老年冠心病患者不引起心肌损伤。

Objective To evaluate the myocardial injury of using unilateral continous spinal anesthsia（UCSA） on coronary heart disease in elderly patients undergoing hip replacement through checking cardiatroponin I（CTnI） and myocardial enzyme. Methods Sixty-two ASA Ⅱ patients aged 65 - 80 year were randomly divided into two group：UCSA group（ I ,n=31 and continuous epidural anesthesia （CEA, Ⅱ ,n=31 ）. The range and level of sensory block were measured,MAP,HR,SpO2 of pre-anesthesia and post-anesthesia were monitored. ST variation in ECG was recorded. Blood samples were taken before anesthesia, 6h after surgery and on the 1st postoperative day for determination of blood CTnI, CK and CK-MB activities. Results The range of block was only on the operation side and the level of block was lower in the group Ⅰ . MAP in the group Ⅱ was slightly decresed at T3_6. In the group Ⅰ CTnI was at low level and was not significant at each time point. CTnI positive 1 case in the group Ⅰ （3 cases in the group Ⅱ ）. CK and CK-MB increased significantly at 6h after operation and on the 1st postoperative day. The difference between the two groups was not significant. Conclusion UCSA has better analgesia and stable hemodynamics, does not causes myocardial injury on coronary heart disease in elderly people undergoing hip replacement.