依托咪酯靶控输注复合硬膜外麻醉对老年冠心病患者心肌的保护作用

Clinical study of combined etomidate target controlled infusion and epidural anesthesia on myocardium protection in elderly patients with coronary heart disease

目的探讨依托咪酯靶控输注(target controlled infusion,TCI)复合硬膜外麻醉对老年冠心病患者围术期是否具有心肌保护作用。方法择期非心脏手术老年冠心病患者90例,ASAⅡ或Ⅲ级,随机分为3组:丙泊酚TCI组(Ⅰ组),依托咪酯TCI组(Ⅱ组),依托咪酯复合硬膜外麻醉组(Ⅲ组),记录麻醉前(T0)、麻醉诱导时(T1)、拔除气管导管后即刻(T2)、术后6 h(T3)、术后24 h(T4)、术后48 h(T5)的SBP、DBP、HR,并打印各时点的心电图,记录各种心电图变化包括ST-T改变。采血检测各时点血清肌钙蛋白(cTnI)水平。结果 T1时Ⅰ组SBP、DBP明显低于Ⅱ、Ⅲ两组(P<0.01),T3～T5时Ⅲ组HR明显慢于Ⅰ、Ⅱ两组(P<0.05)。T2～T5时Ⅲ组cTnI明显低于Ⅰ组(P<0.05),Ⅰ、Ⅱ两组心电图ST-T段改变较Ⅲ组有明显变化(P<0.05)。结论与单纯丙泊酚(TCI)和依托咪酯(TCI)比较,依托咪酯复合硬膜外麻醉应用于老年冠心病患者非心脏手术能够降低术后cTnI升高程度,对心肌有一定的保护作用。

Objective To investigate the potential myocardial protective effects of etomidate target controlled infusion （TCI） combined with epidural anesthesia in elderly patients with coronary heart diseases. Methods Ninety elderly patients with ASA Ⅱ or Ⅲ undergoing elective abdominal surgery were randomly divided into three group （n=30 each ） ： group Ⅰ （propofol TCI） , group Ⅱ （eto- midate TCI） , and group Ⅲ （etomidate TCI with epidural anesthesia）. SBP, DBP and cTnl were recorded and analyzed before anes- thesia （ T0 ） , during induction （ T1 ） , after extubation （ T2 ） , 6 h （ T3 ） , 24 h （ T4 ） and 48 h （ T5 ） after operation, electrocardiogram was recorded, including various electrocardiographic changes in ST-T. Results SBP and DBP significantly lower in groups Ⅱ and Ⅲ at T1 than those in group Ⅰ （P 〈 0.01 ） , HR at the T3 to T5 was obviously faster in groups Ⅰ and Ⅱ than that in group m （ P 〈 0. 05 ）. CTnI at T2 to T5 was significantly lower in group m than that group Ⅰ （ P 〈 0.05 ） , and the change of ST-T in electerocardiogram was observed more obious groupsⅠ and Ⅱ than that in groupⅢ （ P 〈 0. 05 ）. Conclusions Combined etomidate TCI with epidural anes- thesia in elderly patients with coronary heart diseases could reduce the elevation of postoperative level of cTnT, which indicated the poential protective on myocardium.