胸段硬膜外阻滞对冠心病患者围术期心肌保护的临床观察

目的比较单纯全麻和全麻复合胸段硬膜外阻滞（TEA）对冠心病患者开胸手术围术期平均动脉压、心率、ST-T段的变化及肌钙蛋白T（TnT）释放水平的影响。方法30例开胸手术患者随机均分为两组。Ⅰ组仅采用单纯全身麻醉,Ⅱ组术中采用TEA复合全身麻醉,观察两组围术期平均动脉压、心率、ST-T段的变化及TnT释放水平。结果各个时间点Ⅰ组患者的平均动脉压、心率明显高于基础值（P〈0.05）,Ⅱ组各时点无差异（P〉0.05）;两组患者心肌缺血改善Ⅰ组总有效率为33.3%,Ⅱ组总有效率为86.7%;TnT含量在术后1h开始升高（P〈0.05）,24h达峰值（P〈0.05）,术后48h有所下降,组间比较术后24h及48hⅡ组患者TnT水平低于Ⅰ组（P〈0.05）。结论胸段硬膜外阻滞复合全麻组患者的血液动力学稳定,心肌缺血改善明显,TnT值明显低于单纯全麻组,能有效地抑制术中应激反应,减轻心肌损伤,有利于其预后。

Thoracic epidural anesthesia on coronary heart disease in patients with perioperative myocardial protection in clinical observation

Objective Quite pure general anesthesia and outside general anesthesia compound thoracic epidural anesthesia （TEA） to hold the chest surgery to coronary disease patient to encircle the technique time average arterial pressure,the heart rate,the ST-T section change and myo-calcium protein T （TnT） releases the level the influence.Methods 30 examples open chest surgery patients were divided equally two groups stochastically.The groupⅠ only used the pure general anesthesia,In the group Ⅱ technique used the TEA compound general anesthesia,observed two groups to encircle the technique time average arterial pressure,the heart rate,the ST-T section change and the TnT release level.Results Each time selected I group of patient＇s average arterial pressure,the heart rate to be higher than the foundation value obviously （P0.05）,GroupⅡ various points in time do not have the difference （P0.05）;Two group of patient cardiac muscle ischemia improvement situation groupⅠ total effectiveness was 33.3%,Group Ⅱ total effectiveness was 86.7%;TnT content after the technique 1h started to elevate （P0.05）,24h reached the peak value （P0.05）,after the technique,48h drop,after the group compares the technique,24h and 48h The groupⅡ patient TnT level was lower than Group Ⅰ （P0.05）.Conclusion Chest Duan Yingmo hinders the compound general anesthesia group patient＇s blood dynamics to be stable,the cardiac muscle ischemia improvement is obvious,the TnT value is lower than the pure general anesthesia group obviously,can suppress in the technique the stress to respond effectively,reduces the cardiac muscle damage,advantageous its prognosis.