Objective:To investigate the clinical effect and regulating plant-nerve effect of thoracic epidura anesthesia for coronary disease sufferers.Methods:To choose 60 coronary disease sufferers,ASAⅡ～Ⅳ,divide into two groups:Group Ⅰ is collate group ,general medical therapy;GroupⅡ is therapy group,choose T4～5 epidural space insert catheter,drug use 0.8％ Lidocaine,control level of anesthesia between T1～5, then continue infuse 0.8％ Lidocaine(2～3)ml/h with syringe pump,last 5 days,enregister the sufferers's Heart Rate Variability(HRV);low frequency (LF);high frequency(HF)and their ratio(LF/HF)after inject 30min ,12h,24h,72h,120h.Results:After epidural anesthesia,all of the sufferers's LF、HF、LF/HF fell(P＜0.05);LF fell markedly than HF,so LF/HF fell too (P＜0.05);all the sufferers's guide line of Heart Rate Variability with 12h appreciably rise than those within 3h ,but there is not statistical significance (P＜0.05); after pull out epidural catheter 6h ,guide line of HRV has significant difference between those after epidural anesthesia (P＜0.05)guide line of HRV has no significant difference between preoperative and postoperation(P＜0.05).Condusion:Thoracic Epidura Anesthesia can comparatively enhance pneumogastric nerve strain,partly,reversibly hocus T1～5 sympathetic nerve afferent fibers and centrifugal fiber,lead to a dilatation of vasa coronaria,and ameliorate the blood supply and oxygen supply of Izeg(ischemic region),it has feasibility for clinical treatment of coronary disease.%目的:明确高位硬膜外阻滞对冠心病患者的植物神经调节作用及治疗意义,以便为这一新方法提供经验和理论依据.方法:选择ASAⅡ～Ⅳ级冠心病患者60 例,随机分成两组,每组30 例.I组为对照组,常规内科治疗,II 组患者选取T4～5 硬膜外间隙穿刺置管,以微量注射泵继续输注0.8% 利多卡因约(2～3)ml/h,持续5d,给药后30min,12h,24h,72h,120h 分别记录患者的HRV 低频(LF),高频(HF) 及低高比值(LF/ HF),并比较两组患者血压心率的变化情况.结果:常规内科治疗患者,血压心率变化不明显,而应用高位硬膜外阻滞后患者的血压和心率下降明显,高位硬膜外阻滞后,患者LF 、HF 、LF/HF 均降低(P<0.05),LF 降低程度显著大于HF 的降低程度,LF/HF 同时降低(与阻滞前相比,P<0.05),阻滞12h 之后患者HRV 的各项指标与3min 之内相比略有升高,但不存在显著性差异(P>0.05).结论:高位硬膜外阻滞可相对提高迷走神经的张力,局限性、可逆性地阻滞T1～5 支配心脏的交感神经传入和传出纤维,引起冠状血管扩张,由此改善缺血区的血供和氧供,对于冠心病临床治疗具有可行性.
展开▼
