硬膜外阻滞在心肌缺血患者胸部手术的应用

目的探讨心肌缺血患者胸部手术时胸段硬膜外阻滞的应用效应，并与单用全麻者进行比较。方法40例患者随机分为对照组（A）和硬膜外阻滞组（B），每组20例。A组单行静吸复合全麻；B组先行硬膜外穿刺用药，阻滞效果确切后加用静吸复合全麻。记录麻醉前（基础值，T0）、硬膜外阻滞完善后（T1）、诱导用药后（T2）、插管时（T3）、手术开始时（T4）、术中探查时（T5）、拔管时（T6）患者平均动脉压、心率、心电图变化。结果A组术中MAP、RPP明显增加（P〈0．05或P〈0．01），S－T段下移幅度也显著增大（P〈0．05）；而B组术中MAP较稳定，HR、RPP显著降低（P〈0．05），S-T段下移幅度变化不明显（P〉0．05）；组间比较均有显著性差异（P〈0．05或P〈0．01）。结论静吸复合全麻加用硬膜外阻滞较单纯全麻更能维持循环功能稳定，且可降低心肌氧耗，改善供氧，具有保护作用。

The Application of Epidural Block for Patients with Myocardial Ischemia Received Thoracic Surgery

Objective To investigate the effects of epidural block on patients with myocardial ischemia during thoracic surgery,and compare with general anesthesia alone. Methods Forty patients were divided randomly into control group（A） and epidural block group（B）,20 cases each. Group A received general anesthesia alone,group B first epidural puncture medication,and then received general anesthesia. Before anesthesia（basic value T0）,after epidural block perfect（T1）,after induction treatment（T2）,intubation（T3）,at the beginning of surgery（T4）,during exploration （T5）, extubation （T6）, mean arterial pressure （MAP）, heart rate （HR）, electrocardiogram changes were recorded. Results In group A, MAP, RPP was significantly increased（P 〈 0.05, P 〈 0.01 ）, and downward shift distance of S-T section also increased significantly （P〈 0.05） ,while in group B,MAP more stable, HR, RPP decreased significantly（P〈 0.05）. And downward shift distance of S-T section did not change significantly （P 〉 0.05）, but between the groups were significantly different （P 〈 0.05, P 〈 0.01 ）. Conclusion General anesthesia plus epidural block can be more effective in maintaining circulatory function stability and reducing myocardial oxygen consumption,improve myocardial oxygen supply ,has a protective effect.