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目的:探讨冠心病病人于围术期采用高位胸段硬膜外腔交感神经阻滞对提高缺血性心脏病(冠心病)病人围术期安全性的效果。方法:术前合并有冠心病心肌缺血老年患者40例,年龄65～90岁,ASA分级Ⅱ或Ⅲ级,随机分为2组:A组(n=20)根据病人术前情况,于术前1～6天或手术当天开始高位胸段硬膜外腔交感神经阻滞(HTESB)治疗,一直维持到术后拆线或更长时间。B组(n=20)术前不采取HTESB治疗,术中根据情况给予艾司络尔或其它治疗药物。观察并记录2组病人MAP、HR、ST-T、心肌酶的变化。两组病人根据手术情况选择神经阻滞麻醉或全身麻醉。结果:A组病人心率较治疗前明显降低P<0.01,ST-T段抬高或降低得到改善。心肌酶较术前未见增高。B组病人心率术前及术中增加或用药后降低,ST-T段抬高或降低未见改善,心肌酶较术前增高。结论:冠心病病人于围术期采用高位胸段硬膜外腔交感神经阻滞可以改善缺血性心脏病(冠心病)病人围术期心肌缺血,增加氧供,降低氧耗,可以提高此类病人围术期的安全性。
Objective: To investigate the effect of perioperative high-thoracic epidural sympathetic nerve block in patients with coronary heart disease during perioperative period to improve the safety of patients with ischemic heart disease (CHD). Methods: Forty elderly patients with coronary heart disease and myocardial ischemia before operation were enrolled in this study. They were randomly divided into two groups: Group A (n = 20) according to the preoperative condition, High thoracic epidural block (HTESB) treatment was performed 1 to 6 days prior to surgery or on the day of surgery and was maintained until postoperative stitching or longer. Group B (n = 20) did not receive HTESB before surgery, and esoslot or other treatments were given during the operation. The changes of MAP, HR, ST-T and myocardial enzymes in two groups were observed and recorded. Two groups of patients according to the surgical conditions to choose nerve block anesthesia or general anesthesia. Results: The heart rate of group A was significantly lower than that before treatment (P <0.01), and the elevation or decrease of ST-T was improved. No increase in myocardial enzymes compared with preoperative. The heart rate of patients in group B increased preoperatively and intraoperatively or after treatment, and the improvement or decrease of ST-T segment did not improve. The level of myocardial enzymes increased compared with that before operation. Conclusion: Perioperative use of high thoracic epidural sympathetic nerve block in patients with coronary heart disease can improve perioperative myocardial ischemia, increase oxygen supply and reduce oxygen consumption in patients with ischemic heart disease (CHD), and can improve Perioperative safety of such patients.