星状神经节阻滞对非体外循环冠状动脉旁路移植术中心肌损伤的影响

The effect of stellate ganglion block on myocardial injury in patients with non-extracorporeal coronary artery bypass surgery

目的:了解星状神经节节阻滞对接受非体外循环冠状动脉旁路移植(CABG)术中心肌功能的具体影响,为临床患者疾病诊治提供经验。方法:2013年2月至2016年11月期间,对我院收治的90例CABG术患者进行了临床对照研究,根据麻醉具体方式均分为对照组(常规性的麻醉诱导和维持)和观察组(麻醉诱导和维持之前进行患者右侧的星状神经节阻滞),每组均为45例患者。比较不同时点(麻醉前、麻醉诱导后即刻、劈胸骨后即刻、开始旁路移植术时)心肌损伤相关生化指标(肌钙蛋白、肌酸激酶同工酶、Bcl-2蛋白、Bax蛋白、心功能相关激素或活性肽(包括心肌组织中肾上腺素、去甲肾上腺素、神经肽Y、血管活动肠肽)、心功能临床检测指标(包括左心室舒张最低压、左心室舒张末压、心率、冠状动脉流量、左心室内压最大变化速率)的差异。结果:两组cTnL、CK-MB、Bcl-2、Bax、EPI、NE、NPY、VIP、LVDP、LVEDP、HR、CH、±dp/dtmax等指标,均差异有统计学意义(P<0.05);两组T0时点比较,各项指标差异无统计学意义(P>0.05);T1时点CK-MB、Bax、EPI,T2时点cTnL、CK-MB、Bcl-2、Bax、EPI、NE、VIP、LVDP、LVEDP、CH、±dp/dtmax,T3时点EPI、NE、VIP、LVDP、LVEDP、CH、±dp/dtmax,差异有统计学意义(P<0.05);两组不同时点心功能相关的各指标检测结果比较:心肌损伤相关生化指标(cTnL、CK-MB、Bcl-2、Bax)、心功能相关激素或活性肽(EPI、NE、NPY、VIP)、心功能临床检测指标(LVDP、LVEDP、HR、CH、CH)各项指标均有显著改变。结论:麻醉诱导和维持之前进行患者右侧的星状神经节阻滞,用于因冠状动脉梗阻而进行CABG术的患者,有助于提高其保持血流动力学的稳定,减轻心脏应激反应,尽量保有原有心肌功能。

Objective: Understand stellate neural successively block to accept the extracorporeal circulation in patients with coronary artery bypass(CABG)surgery clinical effect, analysis the anesthesia for the patients with myocardial function of the specific impact, provide theory for clinical diagnosis and treatment of disease in patients with experience. Methods: In February 2013-during November, 2016, 90 cases in our hospital in patients with CABG conducted a controlled clinical studies, according to the specific way of anesthesia were divided into control group(routine anesthesia induction and maintenance)and experimental group(before anesthesia induction and maintenance of stellate ganglion block on the right side of the patient), are all 45 patients in each group. Compare different point(before anesthesia, after anesthesia induction, right against the chest bone immediately after, immediately began to bypass)myocardial injury related biochemical indicators(cTnL, CK-MB, and the Bcl-2, Bax cardiac function related hormones or active peptide(including EPI, NE, NPY, VIP), cardiac function in clinical detection index(including LVDP, LVEDP, HR, CH, + dp/dtmax)statistical differences. Results: Two groups of objects four point biochemical indicators of myocardial injury, the experimental group and control group cTnL and CK-MB, the Bcl-2, Bax, EPI, NE, NPY, VIP, LVDP and LVEDP, HR, CH, + dp/dtmax indexes have significant changes(P < 0.05);The T0 time points of the two groups showed no statistical significance(P> 0.05). Two groups of objects T1 time CK-MB, Bax, EPI significant difference(P < 0.05), T2 point cTnL, CK-MB, the Bcl-2, Bax, EPI, NE, VIP, LVDP and LVEDP, CH, plus or minus dp/dtmax significant difference(P< 0.05), T3 point EPI, NE, VIP, LVDP, LVEDP, CH, + dp/dtmax significant difference(P < 0.05);Two groups of different object point cardiac function related repeated measurement variance analysis of monitoring result of each index, myocardial injury related biochemical indicators(cTnL, CK-MB, the Bcl-2, Bax,), cardiac function related hormones or active peptide(EPI, NE, NPY, VIP), cardiac function in clinical detection index(LVDP, LVEDP, HR, CH and CH) due to the specific differences between groups treatment factor and time factor, together with the time of interaction between groups, the indicators of the two groups were significantly different, and all the indicators were significantly changed over time. Conclusions: Before anesthesia induction and maintenance of stellate ganglion block on the right side of the patients, to bypass surgery due to coronary artery obstruction patients, help to improve its maintain hemodynamic stability, reduce cardiac stress reaction, try to keep the original myocardial function.