全麻或硬膜外麻醉对高龄伴无症状心肌缺血患者循环系统的影响

The influence of general anesthesia or epidural anesthesia on circulatory system of old patients with silent myocardial ischemia(SMI)during great saphenous varicose operation

目的观察全麻或硬膜外麻醉对高龄伴无症状心肌缺血行大隐静脉手术患者循环系统影响。方法术前24h行动态心电图(Holter)监测,选取年龄70-90岁,ASA分级:Ⅱ-Ⅲ级,择期行单肢大隐静脉手术的伴无症状心肌缺血患者80例,随机分为硬膜外麻醉组(A组)和全身麻醉组(B组),术后48h进行动态心电图(Holter)监测,记录两组患者术中各时间点的血流动力学变化及ST-T段变化情况,观察两组患者术后心血管事件的发生情况,研究两种麻醉方式对高龄伴无症状心肌缺血患者围术期循环影响。结果术前两组患者均检测出患有无症状心肌缺血,全身麻醉组平均动脉压在麻醉后20min内较麻醉前降低,但同一时段ST-T段比较无统计学差异(P>0.05)。术后48h Holter监测显示术后A组心肌缺血及心律失常发生率明显低于B组(P<0.05):术后第一天A组发生窦性心动过缓4例、阵发性室上速5例、房室传导阻滞4例;B组发生窦性心律不齐5例、阵发性室上速6例,房室传导阻滞4例,室早5例。术后第二天A组发生房室传导阻滞5例,房早4例;B组发生窦性心动过速5例,阵发性室上速4例,房室传导阻滞5例,窦性心律不齐2例。Holter示术后48h两组均未发生严重心血管意外事件。结论对于高龄伴无症状心肌缺血患者,硬膜外麻醉对围手术期患者循环影响较小,有利于维持术后患者血流动力学稳定。

Objective To observe the influence of general anesthesia or epidural anesthesia on circulatory system of old patients with silent myocardial ischemia（SMI） during great saphenous varicose operation. Methods Eighty consec- utive patients,aged 70-90 years old with SMI and ASA class Ⅱ or Ⅲ , waiting for great saphenous varicose operation were randomly divided into epidural anesthesia（A）group,general anesthesia（B） group. 24 hours before surgery and 48 hours after surgery DCG were proformed for all the patients,hemodynamics and ST-T changes were measured respec- tively at different time and cardiovascular events after surgery were also observed for comparison and the differences of the influence on circulatory system among old patients with SMI were compared between the 2 groups. Results All the patients of two groups were linked to SMI,mean arterial pressure was decreased in 20 minites after anesthesia compared with preanesthesia in general anesthesia group, but there was no significant difference of ST-T changes between the two groups at the same time（P〉0.05） ,48 hours after surgery DCG showed that the incidence of myocardial ischemia and arrhymia in group A was significantly lower than which in group B（P〈0.05） ：Day 1 after surgery A group had 4 cases of sinus bradycardia , 5 cases of supraventricular tachycardia, 4 cases of atrioventricalar block;group B had 5 cases of si- nus arrhythmia,6 cases of PSVT, 4 cases of atrioventricular block, 5 cases of ventricular premature beat. Day 2 after surgery group A had 5 cases of atrioventricular block, 4 cases of atrial premature beat; group B had 5 cases of nodal tachycardia,4 cases of PSVT, 5 cases of atrioventricular block, 2 cases of sinus arrhythmia. There was no severe cardio- vascular accidents occurs in 48 hours after surgery in both groups according to Holter results. Conclusion For old pa- tients with SMI,epidural anesthesia has less impact on circulatory system of the patients and much benefits for stabili- zation of hemodynamics after surgery.