硬膜外超前镇痛对老年高血压患者围术期心肌损伤的影响

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1、硬膜外超前镇痛对老年高血压患者围术期心肌损伤的影响摘要：目的比较硬膜外超前镇痛与术后硬膜外镇痛对老年高血压患者围术期心肌损伤的影响。方法择期全麻下拟行上腹部手术的老年患者60例，随机分为术后硬膜外镇痛组(C组)和硬膜外超前镇痛组(P组)。于T7,8椎间隙行硬膜外穿刺并置管。P组于切皮前硬膜外注射0.5ug/mL舒芬太尼+0.15%罗哌卡因混合液15mL,30min后接镇痛泵，以5mL/h的速率硬膜外输注250mLoC组患者术后硬膜外注射混合液15mL,30min后接镇痛泵，以5mL/h的速率硬膜外输

2、注250mLo分别记录不同时段心电图ST段水平和血浆心肌肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白(cTnl)和C反应蛋白(CRP)的浓度。结果术毕拔出气管导管后C组ST段水平明显低于P组(P64yrundergoingelectiveupperabdominalsurgerywererandomlydividedinto2groups(n=30each)：Ipre~emptiveepiduralanalgesiagroup(groupP)andIIpostoperativeepiduralanal

3、gesiagroup(groupC)・Amixtureof0.5ug/mlsufentaniland0.15%ropivacaine250mlwasusedforepiduralanalgesiainbothgroup・TheepiduralcatheterwasplacedatT7~8interspace・Theepiduralregimenincludedaloadingdoseof15mlfollowedafter30minbycontinuousepiduralinflusionat5ml/

4、hfor50h.IngroupPtheepiduralanalgesiawasstartedat20minbeforeskinincision，whileingroupCafteroperationwhenthepatientsemergedfromgeneralanesthesiaandwereextubated.BISwasmaintainedat40-60.ThechangesinSTsegmentwererecordedbeforeanesthesia,afterintubationands

5、urgicalexplorationandimmediatelyafterextubation.MyocardialischemiawasdefinedasSTsegmentdepression$0・lmVformorethan1min.Bloodsampleswereobtainedfromperipheralveinofupperlimb,beforeanesthesis(TO),1hafterskinincision(T1),attheendofoperation(T2)and6,24haft

6、eroperation(T3-4)fordeterminationofplasmaCK-MBactivityandplasmaconcentrationsofcTnlandCRP・ResultsTheSTsegmentdepressionwassingnificantlydeeperafterextubationingroupCthaningroupP・TheplasmaCK-MBactivityandconcentrationsofcTnlandCRPweresingnificantlyincre

7、asedafteroperationascomparedwiththebaselinevaluesatTO.TheplasmalevelsofcTnlandCRPweresingnificantlyhigheringroupCthaningroupPat6，24hafteroperation.ConclusionPre-emptiveepiduralanalgesiacanmoreeffectivelyinhibitstressresponsethanpostopera.tiveepiduralan

8、algesiatoupperabdominalsurgeryinelderlyhypertensivepatients,andmayhaveaprotectiononmyocardium.Keywords：Analgesia；Epidural；Aged；Hypertensive；Myocardialinjury老年高血压患者应激状态下对循环系统改变的适应能力及调节能力降低，麻醉和手术期间易出现血压剧烈波动。研究显示，连续胸部硬膜外镇痛能降低术后心肌肌钙蛋白（cTnl）