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首页> 外文期刊>Journal of cardiothoracic and vascular anesthesia >High thoracic epidural analgesia in cardiac surgery: Part 1 - High thoracic epidural analgesia improves cardiac performance in cardiac surgery patients
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High thoracic epidural analgesia in cardiac surgery: Part 1 - High thoracic epidural analgesia improves cardiac performance in cardiac surgery patients

机译：心脏外科手术中的高胸腔硬膜外镇痛药：第1部分-心脏外科手术患者的高胸腔硬膜外镇痛药可改善心脏性能

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Objective: The purpose of this study was to evaluate the perioperative cardioprotective effect of high thoracic epidural analgesia (HTEA), primarily expressed as an effect on cardiac performance and hemodynamics in patients undergoing cardiac surgery. Design: A randomized, prospective study. Participants: Sixty low-to-moderate risk patients between the ages of 65 and 80 years scheduled for elective coronary artery bypass graft surgery with or without aortic valve replacement. Setting: A university hospital. Intervention: Patients randomized to receive HTEA as a supplement to general anesthesia. Measurements and Main Results: Perioperative hemodynamic measurements, perioperative fluid balance, and postoperative release of cardiac enzymes were collected. The end-diastolic volume index (EDVI), the stroke volume index (overall 38 v 32 mL), the cardiac index (overall 2.35 v. 2.18 L/minute/m 2), the central venous pressure, and central venous oxygenation were higher in the HTEA group. The mean arterial blood pressure was marginally lower in the HTEA group, whereas no difference was noted in the heart rate or peripheral saturation between the groups. No differences were found in the postoperative levels of troponin T and CK-MB between groups. NT-proBNP changed over time (p 0.001) and was lower in the HTEA group (p = 0.013), with maximal values of 291 ± 265 versus 326 ± 274. Conclusions: The findings of a higher stroke volume index and central venous oxygenation without an increase in heart rate or mean arterial pressure suggest that HTEA improves cardiac performance in elderly cardiac surgery patients.
机译：目的：本研究旨在评估高胸腔硬膜外镇痛剂（HTEA）的围手术期心脏保护作用，主要表现为对接受心脏手术的患者的心脏性能和血液动力学的影响。设计：一项随机，前瞻性研究。参加者：60例年龄在65至80岁之间的中低风险患者，计划行择期冠状动脉搭桥术并伴或不伴行主动脉瓣置换术。地点：大学医院。干预：随机接受HTEA补充全身麻醉的患者。测量和主要结果：收集围手术期的血液动力学测量，围手术期的液体平衡和术后心脏酶的释放。舒张末期容积指数（EDVI），中风容积指数（整体38 v 32 mL），心脏指数（整体2.35 v。2.18 L / min / m 2），中心静脉压和中心静脉氧合较高在HTEA组中。 HTEA组的平均动脉血压略低，而两组之间的心率或外周血饱和度没有差异。两组之间肌钙蛋白T和CK-MB的术后水平无差异。 NT-proBNP随时间变化（p <0.001），而在HTEA组则较低（p = 0.013），最大值为291±265与326±274。结论：脑卒中体积指数和中心静脉氧合升高的结果没有增加心率或平均动脉压提示HTEA可改善老年心脏手术患者的心脏性能。

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