两种不同麻醉方法对老年高血压患者心血管相关因素的影响

Effects of Two Different Anaesthesia Techniques on Cardiovascular Factors in Elderly Patients with Hypertension

目的比较全麻与硬膜外麻醉复合全麻两种不同的方法对老年高血压患者围术期血清肌酸激酶(CK)和肌酸激酶同工酶(CK-MB)等心血管相关因子的影响。方法上腹部择期手术老年高血压患者60例,ASAⅡ～Ⅲ级,随机分成丙泊酚靶控输注全麻组(P组,n=30)与硬膜外麻醉复合丙泊酚靶控输注全麻组(PE组,n=30)。记录麻醉前(T0)、术毕(T1)、术后6 h(T2),24 h(T3),48 h(T4)的血压、心率,并检测血清CK、CK-MB、乳酸脱氢酶(LDH)、谷草转氨酶(AST)及心肌肌钙蛋白-Ⅰ(cTn-Ⅰ)的变化。结果与T0比较,PE组各时点血压显著降低;P组舒张压显著增高,T1～T4时点显著高于PE组(P<0.05或0.01)。与T0比较,两组T1～T4时CK均显著增高,T3、T4时P组显著高于PE组(P<0.05或0.01)。T2时P组CK-MB显著高于PE组(P<0.05)。与T0比较,两组T1～T3时LDH显著增高(P<0.05或0.01)。P组AST在T1～T4时和PE组在T3时显著增高(P<0.05或0.01),T2时P组显著高于PE组(P<0.05或0.01)。与T0比较,P组T1～T4时点cTn-Ⅰ显著增高(P<0.05或0.01),PE组T1时显著降低(P<0.05),T1、T3时P组cTn-Ⅰ显著高于PE组(P<0.05或0.01)。结论与全麻比较,硬膜外麻醉复合全麻用于老年高血压患者非心脏手术时更能够减少围手术期心肌的损害。

Objective To investigate the effects of general anesthesia and epidural anesthesia combined with general anesthesia on perioperative creatine kinase（CK） and MB isoenzyme of creatine kinase（CK-MB） in elderly patients with hypertension. Methods Forty ASA Ⅱ or Ⅲ elderly patients undergoing elective abdominal surgery were randomly divided into two groups（n=30 each）： Group P,receiving propofol target controlled infusion（TCI） and Group PE,receiving combined propofol TCI with epidural anesthesia.Blood pressure,heart rate,serum CK,CK-MB,LDH,AST and cTn-Ⅰ were recorded before anesthesia.T0 cardiac drugs usages and VAS scores at 6,24,48 hours after operation were recorded.Results Postoperative blood pressure in Group PE was significantly decreased.Diastolic pressure in Group P,at the end of anesthesia（T1）,and at 6 h（T2）,24 h（T3）,48 h（T4）after operation,increased significantly when compared with that of T0.Postoperative blood pressure in Group P was significantly higher than in Group PE.VAS scores and the usage of cardiac drugs in Group P were markedly lower than those of Group PE.CK,CK-MB,LDH and AST were also changed in both groups.CTn-Ⅰin Group P increased significantly after operation when compared with that of T0.CTn-Ⅰ in Group PE decreased significantly at T1 and was significantly lower than that of Group P at T1 and T3.Conclusion Epidural anesthesia combined with general anesthesia in elderly patients with hypertension has a better protective effect on myocardial injury compared with general anesthesia only.