摘要
目的探讨胸段硬膜外阻滞对不稳定型心绞痛患者心肌损伤的影响。方法选择已被确诊为不稳定型心绞痛患者56例,随机分为观察组(28例)即胸段硬膜外阻滞组和对照组(28例)即常规内科治疗组。观察组患者选择T3～4或T4～5椎间隙,行硬膜外穿刺,穿刺成功后置入硬膜外导管,接4mL/h微量注射泵持续注射0.5%利多卡因,根据病情缓解情况持续1～2周。两组患者均连续动态监测心电图、平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2),于阻滞前及阻滞后1、12、24和72h抽取静脉血标本,测定肌钙蛋白Ⅰ(cTnⅠ)。结果观察组患者于胸段硬膜外阻滞15min后,心绞痛症状全部缓解,视觉模拟评分(VAS)观察组患者明显优于阻滞前及同时段对照组值,而且在整个治疗过程中未再出现心前区疼痛;观察组平均动脉压(MAP)、心率(HR)与阻滞前及同时段对照组比较有不同程度的下降和减慢;血氧饱和度(SpO2)观察组明显优于阻滞前及同时段对照组值;阻滞后观察组cTnⅠ与阻滞前比较无明显的升高,且明显低于同时段对照组值P<0.05。结论胸段硬膜外阻滞可快速缓解由于冠状动脉供血不足引起的缺血性胸痛,扩张冠状动脉,改善心肌血流分布,减少心肌氧耗量,减少心肌梗塞的发生,对不稳定型心绞痛心肌损伤有一定保护作用。
To study effect of thoracic epidural block on myocardium damnification in patients with unstable angina pectoris. Fifty six patients with unstable angina pectoris were divided randomly into study group (n =28) and controlled group (n =28). The patients in study group choose thoracic 3～4 or 4～5 (T3～4 or T4～5) vertebral clearance for puncture and continuously injection 0.5% Lidocaine into extradural clearance(4 mL/h), last out 1～2 week. The patients in controlled group take medicine methods therapy. In preceding block and block 1hour, 12 hour,24 hour and 72 hour later, phlebotomize and mensurate quantum of troponinⅠ. After 15 minute ,the patients in study group lighten angina symptom, visual anaglogue scale (VAS) study group obviously excel preceding block and controlled group. Study group mean arterial pressure (MAP) and rhythm of the heart compare with preceding block and contemporaneous controlled group appear obviously depressing and lowering and saturate of pulse oxygen (SpO2) obviously excel preceding block and contemporaneous controlled group. Study group quantum of troponinⅠappeared obviously reducing, P <0.05. [Conclusion] Thoracic epidural block can obviously improve myocardium damnification in patients with unstable angina pectoris.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2005年第4期588-590,共3页
China Journal of Modern Medicine
关键词
胸段硬膜外阻滞
不稳定型心绞痛
心肌损伤
thoracic epidural block
unstable angina pectoris
myocardium damnification
