丙泊酚静脉麻醉联合硬膜外阻滞对冠心病心肌损伤患者行非心脏手术的心肌保护作用

Protective Effects of Propofol Intravenous Anesthesia Combined with Epidural Anesthesia on Coronary Artery Disease Co-existing Myocardial Injury Patients Undergoing Non-cardiovascular Surgeries

目的:观察冠心病心肌损伤患者行非心脏手术丙泊酚全麻联合硬膜外阻滞对心肌的保护作用。方法:将40例心功能Ⅰ～Ⅱ级择期行腹部外科手术的冠心病患者随机分为丙泊酚全麻组(P组)、丙泊酚全麻联合硬膜外阻滞组(PE组),每组20例。硬膜外阻滞选择T8～9穿刺置管。两组丙泊酚靶控输注血药浓度维持在2～3μg/mL,均给予舒芬太尼0.5μg/(kg·h),同时间断注射维库溴铵。围术期连续监测患者血流动力学及心电图ST段变化,同时检测术前和术毕血清IL-6、IL-8、TNF-α、心肌钙蛋白I(cTnI)和糖原磷酸化酶BB(GP-BB)变化。结果:与术前相比,两组病人术毕血清IL-6、IL-8、TNF-α、cTnI及GP-BB水平均明显升高(P均<0.05);术毕P组血清IL-6、IL-8、TNF-α、cTnI及GP-BB升高明显高于PE组(P均<0.05)。结论:冠心病心肌损伤病人行非心脏手术时用丙泊酚全麻联合硬膜外阻滞对心肌有良好保护作用,此保护作用可能与调控细胞因子有关。

Objective To observe the protective effect of propofol intravenous anesthesia combined epidural anesthesia undergoing non-cardiovascular surgeries in the patients of coronary artery disease co-existing myocardial injury. Methods Forty heart function I～II patients with coronary artery disease scheduled for abdominal operation were randomly divided into two groups （n=20 each）： Group P and Group PE. Epidural anesthesia was performed via the T8-9 interspase in Group PE. Target controlled infusion of propofol was used for maintenance and propofol target blood concentration was set at 2～3 μg/mL. in both groups. Both groups were administered sufentanil with the velocity of 0.5 μg/（kg·h）, and vecuronium was intravenously injected interruptedly. Haemodynamics and ST section of ECG were monitored continuously in perioperative period, while the plasma levels of IL-6, IL-8, TNF-α, cTnl and GP-BB were measured. Results The plasma levels of IL-6, TNF-α, cTnl and GP-BB were higher in postoperation than in preoperation in both groups （P 0.05）. The plasma levels of IL-6, IL-8, TNF-α, cTnl and GP-Bb were significantly higher in group P than in group PE in postoperation （P 0.05）. Conclusion Propofol combined epidural has better effect on lessening myocardial injury than propofol undergoing non-cardiovascular surgeries in those patients co-existing myocardial injury of coronary artery disease, and the regulation on cytokines may contribute to the protection effect.