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|本期目录/Table of Contents|

硬膜外复合全麻对老年开胸患者围术期心肌酶及肌钙蛋白I的影响(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2008年第4期
页码:
474-477
栏目:
临床研究
出版日期:
2008-08-20

文章信息/Info

Title:
Effects of combined epiduraltotal intravenous anesthesia on perioperative myocardial zymogram and troponin I of the myocardium in elderly patients undergoing thoracic surgery
作者:
梁华1;  陈立军2;  王立文1
1.解放军第五医院麻醉科，宁夏 银川 750004； 2.兰州军区总医院心血管外科，甘肃 兰州 730000
Author(s):
LIANG Hua;  CHEN Lijun;  WANG Liwen
Department of Anesthesiology, PLA 5th Hospital, Yinchuan 750004, Ninxia, China
关键词:
麻醉; 全凭静脉; 硬膜外; 胸科手术; 心肌酶谱; 肌钙蛋白
Keywords:
total intravenous anaesthesia; epidural block; thoracic surgery; myocardial zymogram; troponinI
分类号:
R614.24
DOI:
-
文献标识码:
A
摘要:
目的 观察硬膜外复合静脉麻醉对老年开胸手术患者围手术期心肌酶及心肌肌钙蛋白I(cTnI)的影响。方法 择期老年开胸手术患者64例，ASA Ⅰ～Ⅱ级，随机分2组(各32例)：硬膜外复合全凭静脉麻醉组(A组)与全凭静脉麻醉组(B组)。分别于麻醉前、插管及拔管后5 min、术后6、24和48 h采外周静脉血5 ml，测定血清肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、谷草转氨酶(AST)、乳酸脱氢酶(LDH)及cTnI的浓度，同时观察血流动力学变化。结果 A组CK、CKMB、AST、LDH及cTnI显著低于B组(P<0.01)，A组插管及拔管后5 min与麻醉前相比无显著性差异，但术后6 h及24 h与麻醉前相比显著升高(P<0.01)；B组各时间点与麻醉前相比均有不同程度升高(P<0.05)。插管及拔管时，B组收缩压、平均动脉压、心率、收缩压与心率的乘积（RPP）均显著高于麻醉前值(P<0.01)，同期A组无明显波动，组间比较差异显著(P<0.01)。结论 硬膜外复合全凭静脉麻醉用于老年开胸手术能有效降低机体能量代谢和应激反应，减少患者围手术期心肌的损害。
Abstract:
AMI To observe the effects of combined epiduraltotal intravenous anesthesia on perioperative myocardial zymogram and troponin I of the myocardium (cTnI) in elderly patients undergoing thoracic surgery. METHODS Sixtyfour ASA Ⅰ～Ⅱ elderly patients were randomly divided into two groups: combined epiduraltotal intravenous anesthesia (Group A) and total intravenous anesthesia (grou pB). Peripheral blood CK, CKMB, AST, LDH and cTnI were measured before anesthesia, at 5min after intubation and extubation and at 6, 24, 48 hours after operation. Hemodynamics changes were observed. RESULTS Serum CK, AST, LDH and cTnT concentration in group B were higher than those in groupA (P<0.05). Serum CK, AST, LDH and cTnI concentration in group B after operation were significantly higher than those before anesthesia (P<0.05). No changes of CK, CKMB, LDH and cTnI were found in group B. SBP, MAP, HR and RPP were significantly higher than those before anesthesia, during intubation and extubation in group B (P<0.01), but no significant changes were found in group A. CONCLUSION Epidural block combined with total intravenous anesthesia is better for elderly patients undergoing thoracic surgery, because the energy metabolism and stress reaction can be markedly attenuated and it has a better protective effect on myocardial injury induced by operation.

参考文献/References

［1］ Bopp C，Plachky J，Hofer S，et al．Anesthesia and intensive care medicinestatus report. XIIIth International Symposium on Anesthesia in Heidelberg, March 19-21, 2004［J］．Anaesthesist， 2004， 53(9)：871-879．

［2］ 唐学静，吴娱，林明．肌钙蛋白I、CK、CKMB的测定在心肌损伤性疾病中的诊断价值［J］． 大连大学学报， 2004， 25(6)：60-62．

［3］ 刘景泉，王淑萍，苏海，等. 心肌钙蛋白I(CTnI)检测在心肌损伤诊断中的应用［J］. 中华临床医学研究杂志， 2005， 11（22）：3194-3195.

［4］ 粱华，陶国才，郭永军，等．全麻复合胸段硬膜外阻滞用于老年病人食管癌手术的观察［J］． 临床麻醉学杂志, 2004， 20(8)：470-471．

［5］ Ledowski T,Bein B,Hanss R, et al. Neuroendocrine stress response and heart rate variability: a comparison of total intravenous versus balancedanesthesia［J］. AnesthAnalg,2005,101（6）:1700-1705.

［6］ 梁华，王立文，杨焕杰，等. 罗哌卡因与布比卡因复合芬太尼用于老年食管癌根治术后镇痛［J］. 西北国防医学杂志， 2006， 27（4）：273-275.

备注/Memo

备注/Memo:
收稿日期：2007-04-12.通讯作者：梁华，副主任医师，主要从事复合麻醉的研究Email:lianghualianghua@yahoo.com.cn
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