连续腰麻与全麻对心肌钙蛋白和心肌酶影响的比较

连续腰麻与全麻对心肌钙蛋白和心肌酶影响的比较

目的比较连续腰麻(CSA)与全麻（GA）对行下肢骨科手术老年冠心病患者心肌钙蛋白和心肌酶的影响程度。方法选择行下肢骨科手术老年冠心病患者60例，年龄65～90岁，ASAⅡ级，分成CSA组（C组）和GA组(G组)，每组30例。监测记录麻醉前后各时点MAP、HR、SpO2变化及心电图ST段改变情况。在麻醉前、术后第1天采集静脉血，测定心肌钙蛋白Ⅰ(CTnⅠ)、肌酸激酶(CK)及肌酸激酶同工酶（CK-MB）。结果与T0比较，C组内麻醉后各时点MAP、HR、SpO2无显著变化（P>0.05）,G组MAP、HR在T1、T7升高（P＜0.05）；C组CTnⅠ、CK-MB处于低值［≤(0.23±0.03) μg/L，(10.62±3.65) U/L］，麻醉前后无显著变化（P>0.05）；G组CTnⅠ、CK-MB术后第1天［(0.69±0.11)μg/L，(23.10±3.75)U/L)］较麻醉前升高（P＜0.05）,较C组升高（P＜0.05）；两组CK 术后第1天均升高（P＜0.05）。结论CSA镇痛完全，循环功能稳定，不引起下肢骨科手术老年冠心患者CTnⅠ和CK-MB升高；GA气管插管和拔管时可引起老年冠心患者CTnⅠ和CK-MB升高。

[Abstract]ObjectiveTo compare the myocardial injury of using continous spinal anesthesia (CSA)and general anesthesia(GA) on coronary heart disease in elderly patients through checking cardiatroponin Ⅰ(CTnⅠ) and myocardial enzyme.MethodsSixty ASA Ⅱpatients aged 65-90 years were divided into two group：CSA group(C,n=30)and GA group (G,n=30) . MAP、HR、SpO2 at pre-anesthesia and post-anesthesia were monitored.ST variation in ECG was recorded.Blood samples were taken before anesthesia and on the first postoperative day for determination of blood CTn Ⅰ,CK and CK-MB activities.ResultsMAP、HR、SpO2 around anesthesia in the group C was not remarkable changces. MAP、HR in the group G was increased at T1,T7 . CTn Ⅰand CK-MB in the group C were at low level ,not changes. CTn Ⅰand CK-MB in the group G was increased on the first postoperative day. CK in each group was increased significantly on the first postoperative day.Conclusion CSA has better analgesia and stable hemodynamics ,and does not increase CTn Ⅰand CK-MB on coronary heart disease in elderly people. GA increase CTnⅠand CK-MB at tracheal intubation.

[Key words]Coronary heart disease in elderly people；Continuous spinal anesthesia；General anesthesia；Cardiatroponin Ⅰ；Myocardial enzyme

老年冠心病患者因心血管系统衰老、退变及代偿能力差，麻醉和手术期间血压更易波动，可能发生心肌缺血损伤及心肌梗死，选择适当的麻醉方法可降低手术麻醉期心血管事件的发生率。通过观察血中心肌钙蛋白Ⅰ(CTnⅠ)、心肌酶及心电图ST段变化，比较连续腰麻（CSA）与全身麻醉(GA)影响心肌血供和心肌损伤情况，探讨CSA对行下肢骨科手术老年冠心患者的安全性。

1资料与方法