高位胸段硬膜外阻滞治疗顽固性心绞痛的临床研究

CLINICAL STUDY OF HIGHER THORACIC EPIDURAL ANESTHESIA ON PATIENTS WITH REFRACTORY ANGINA PECTORIS

目的 :观察高位胸段硬膜外阻滞 (TEA)对顽固性心绞痛 (RAP)的治疗效果 ,监测血压 心率和心电图变化并检测血浆内皮素 1(ET 1)浓度的变化。方法 :61例RAP患者接受TEA治疗 ,停用硝酸甘油。观察疗效 血流动力学和心电图变化 ,同时检测血浆TEA前及TEA后第 14天ET 1水平。结果 :TEA治疗后心绞痛缓解率 10 0 % ,TEA后 30分钟、2 4小时、第 7天和第 14天血压 心率虽较TEA前有所下降 ,但均无显著差异 (P >0 .0 5 ) ;心电图ST段压低导联数和ST压低值显著减少 (P <0 .0 5 ) ;TEA后第 14天ET 1浓度较TEA前明显下降 (P <0 .0 1)。结论 :TEA治疗对RAP患者疗效满意并改善心肌供血 ,可能与ET 1浓度下降有关。

Objective: To investigate the role of higher thoracic epidural anesthesia (TEA) on patients with refractory angina pectoris (RAP), the concentration of endothelin 1 (ET 1) was monitored . Methods: Sixty one patients accepted TEA as the main therapy, and stopped nitroglycerin infusion. Blood pressure, heart rate and electrocardiogram(ECG) were monitored respectively before and after TEA. The clinical effect of TEA was recorded and the concentration of ET 1 was investigated before and after TEA. Results: The rate of patients'chest pain relief was 100% after TEA. Blood pressure and heart rate showed a mild decrease but the difference wasn' t significant compared with that before TEA( P >0.05). The degree of ST depression and total number of ST depression channels of ECG decreased significantly after TEA ( P <0.05). Meanwhile, the concentration of ET 1 decreased significantly after TEA treatment ( P <0.01). Conclusions: TEA may be used as a promising therapeutic approach for patients with refractory angina pectris, which may be associated with the decrease of the serum concentration of ET 1.