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研究

Effect of general anesthesia or epidural anesthesia on circulatory system in senile patients with silent myocardial ischemia

目的研究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。方法选择我院2016年11月—2017年11月收治的择期行单肢大隐静脉手术、伴无症状心肌缺血患者60例,随机分为硬膜外麻醉组(A组)和全身麻醉组(B组)各30例。对比2组血流动力学变化及ST-T段变化情况、术后心血管事件发生率。结果麻醉后,2组心率比较差异无统计学意义(P>0.05);A组平均动脉压高于B组,差异具有统计学意义(P<0.05);2组ST-T段平均变化程度、缺血总负荷、心律失常发生率比较,差异无统计学意义(P>0.05);A组心肌缺血发生率低于B组,差异具有统计学意义(P<0.05)。结论硬膜外麻醉对高龄伴无症状心肌缺血患者循环系统影响较小,有利于稳定血流动力学,具有较高的安全性。

Objective To study the effect of general anesthesia or epidural anesthesia on circulatory system in senile patients with silent myocardial ischemia（SMI）. Methods 60 SMI patients with selective single-limb great saphenous vein surgery from June 2017 to November 2017 were selected,and they were randomly divided into epidural anesthesia group（A group） and general anesthesia group（B group）,30 cases in each group. The changes of hemodynamics and ST-T segment,postoperative cardiovascular events were compared between the two groups. Results After anesthesia,there was no statistical difference in the heart rate between the two groups（P〈0.05）;The average arterial pressure of A group was higher than that of B group（P〈0.05）;There was no statistical difference in the average changes of ST-T segment,total ischemic burden,incidence of arrhythmia between the two groups（P〈0.05）;The incidence of myocardial ischemia in A group was lower than that in B group（P〈0.05）.Conclusion Epidural anesthesia has less effect on circulatory system in senile patients with SMI,it can stabilize hemodynamics and have higher safety.