胸段硬膜外阻滞对非体外循环冠状动脉搭桥围术期心肌酶及心电图ST段的影响

目的 分析胸段硬膜外阻滞对非体外循环冠状动脉搭桥术（OPCAB）围术期心肌酶及心电图ST段的影响。方法 40例择期行OPCAB患者按随机分为两组：观察组为高位胸段硬膜外阻滞复合全麻组；对照组为单纯全麻组，在麻醉诱导前（T0）、术后1h（T1）、24h（T2）、48h（T3）4个时间点抽取血样测定血浆肌钙蛋白（cTnⅠ）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）值并记录患者1-7d心电图ST段的动态变化。结果 所有患者手术经过及术后恢复顺利，无一例转为体外循环。术前两组间各项指标差异均无统计学意义（P〉0．05）。两组术后各时间点CK、CK-MB、cTnⅠ均较术前明显升高（P〈0．05）。与对照组相比，观察组术后各时间点明显降低（P〈0．05）。心电图监测显示观察组术后ST段抬高导联数3d内较术前均有所增多，在术后第4天开始下降，术后第7天已恢复至术前水平。而对照组各时间点增多均较观察组更明显，在第5天开始下降，但一直较术前高（P〈0．05）。术后两组各时间点ST段下移的导联数与术前比较差异无统计学意义（P〉0．05）。结论 硬膜外阻滞复合全麻为OPCAB围术期心肌提供良好保护作用。

Effects of thoracic epidural anesthesia on level of serum cardiac troponin I,creatine kinase and creatine kinase-MB and ST segment change in patients undergoing off-pump coronary artery by- pass surgery

Objective To investigate the effect of serum thoracic epidural anesthesia on hemodynamic parameters and the changes of cardiac troponin Ⅰ （cTnⅠ） , creatine kinase （CK）and creatine kinase -MB （CK-MB） activities and ST segment change undergoing off-pump coronary artery bypass （OPCAB） surgery. Methods Forty ASA Ⅱ - Ⅲ patients undergoing OPCAB were divided randomly into two groups, 20 of them were given thoracic epidural anesthesia plus general anesthesia as the study group. The other as the control group received general anesthesia only. Serum samples were collected before operation, at the end of operation 1 h, 24 h, and 48 h for determination of CK, CK-MB, cTnl activities. The changes of ST segment were monitored by 12 lead electrocardiogram system before operation （as baseline values）,and 1-7 d after operation. Results The data of two groups obtained before the operation had no difference（P 〉 0.05 ）. CK, CK-MB and cTnl activities at 1 h, 24 h, 48 h postoperative in two groups were significantly higher than preoperative （P 〈 0.05 ）. CK, CK-MB and cTnl activities in the study group at 1 h, 24 h, 48 h postoperative were significantly higher than those in the control group （P 〈 0.05）. The leads of ST segment elevation were increased more significantly in the study group as compared to the baseline values 1-3 d after operation （P 〈 0.05）, the leads of ST segment elevation were begun to decrease on the 4th day after operation and arrived to the same as the one on the 7th day. The leads of ST segment elevation were increased more significantly in the control group than those in the study group after operation. The leads of ST segment elevation were begnn to decrease on the 5th day after operation in the control group but it was still higher than those before operation （P 〈 0.05 ）. The leads of ST segment depression had no significance as compared to the baseline values among the two groups（P 〈 0.05 ）. Conclusion Thoracic epidural anesthesia can make a bette