摘要
目的评价胸段硬膜外阻滞复合全身麻醉对老年高血压病患者围术期的心肌保护作用。方法择期胸部手术高血压患者60例,ASA分级为Ⅱ级或Ⅲ级,NYHA心功能为Ⅱ级或Ⅲ级,心胸比0.52-0.63,年龄65-74岁,体重55-75 kg,性别不限。采用随机数字表法,分为实验组（E组,n=30）和对照组（C组,n=30）。实验组采用胸段硬膜外阻滞复合全身麻醉,对照组采用气管插管全麻,于术前（T1）、切皮后1 h（T2）、术毕（T3）和术后24 h（T4）分别取静脉血标本,测定血清心肌酶及肌钙蛋白I（c Tn I）水平,记录患者术后呼吸机治疗时间、ICU停留时间及住院时间。结果与C组比较,E组血清肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）的活性和c Tn I浓度,Tl时差异无统计学意义（P〉O.05）,T2时开始明显升高,与Tl时比较,T2、T3、T4时两组以上指标均明显升高（P〈0.01）,且同一时间点比较差异有统计学意义（P〈0.01）;术后呼吸机治疗时间、ICU停留时间及住院时间E组较C组明显缩短（P〈0.001）;而插管后、切皮时、术中、拔管时两组HR、MAP比较差异也有统计学意义（P〈0.01）。结论胸段硬膜外阻滞复合全身麻醉可减轻老年高血压病患者围术期的心肌损伤,可产生有效的心肌保护作用。
Objective To evaluate protective function of thoracic epidural block combined with general anesthesia on perioperative myocardium of elderly patients with hypertension. Methods 60 hypertension patients with ASA Ⅱ or Ⅲ,NYHA Ⅱ or Ⅲ,cardiothoracic ratio 0. 52 - 0. 63,age 65 - 74 yr,male or female and weight 55 - 75 kg undergoing selective thoracic operation were selected as study objects. Random number table was adapted to divide all the patients into experiment group（ group E,n = 30） and control group（ group C,n = 30）. The experiment group were given thoracic epidural block combined with general anesthesia while the control group were given tracheal intubation under general anesthesia. Venous blood samples were collected before operation（ T1）,one hour after skin incision（ T2）,after the operation（ T3） and 24 hours after the operation（ T4） respectively as well as levels of serum myocardial enzymes and troponin I（ c Tn I） were detected. Meanwhile,time of postoperative mechanical ventilation treatment,time of staying in ICU and time of hospitalization after operation were recorded,respectively. Results Compared with the group C,differences of activities of serum creatine kinase（ CK）,creatine kinase isoenzyme（ CK-MB）,lactic dehydrogenase（ LDH） and c Tn I concentration were not statistically significant at T1（ P〉 0. 05）. At T2,however,all of the above-mentioned indexes began to obviously increase,they increased significantly at T2,T3 and T4 compared with those at T1（ P〈 0. 01）,and differences of the comparison at the same time were statistically significant（ P〈 0. 01）. Time of postoperative mechanical ventilation treatment,time of staying in ICU as well as time of hospitalization of the group E were obviously shorter than those of the group C（ P〈 0. 001）. Differences of HR and MAP after the intubation,during the skin incision,during operation and at the time of extubation were also statistically significant between the two groups（ P〈 0. 01）. Co
出处
《右江医学》
2015年第4期460-463,共4页
Chinese Youjiang Medical Journal
关键词
心肌酶
肌钙蛋白
复合麻醉
高血压病
心肌损伤
myocardial enzyme
troponin
combined anesthesia
hypertension
myocardial injury
