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Effects of thoracic epidural anesthesia on level of serum cardiac troponin I, creatine kinase and creatine kinase-MB and ST segment change in patients undergoing off-pump coronary artery bypass surgery
Author(s): 
Pages: 17-20
Year: Issue:  3
Journal: CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE

Keyword:  麻醉硬膜外冠状动脉旁路移植术非体外循环;
Abstract: 目的 分析胸段硬膜外阻滞对非体外循环冠状动脉搭桥术(OPCAB)围术期心肌酶及心电图ST段的影响.方法 40例择期行OPCAB患者按随机分为两组:观察组为高位胸段硬膜外阻滞复合全麻组;对照组为单纯全麻组,在麻醉诱导前(T0)、术后1 h(T1)、24 h(T2)、48 h(T3)4个时间点抽取血样测定血浆肌钙蛋白(cTnI)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)值并记录患者1~7d心电图ST段的动态变化.结果 所有患者手术经过及术后恢复顺利,无一例转为体外循环.术前两组间各项指标差异均无统计学意义(P>0.05).两组术后各时间点CK、CK-MB、cTnI均较术前明显升高(P<0.05).与对照组相比,观察组术后各时间点明显降低(P<0.05).心电图监测显示观察组术后ST段抬高导联数3 d内较术前均有所增多,在术后第4天开始下降,术后第7天已恢复至术前水平.而对照组各时间点增多均较观察组更明显,在第5天开始下降,但一直较术前高(P<0.05).术后两组各时间点ST段下移的导联数与术前比较差异无统计学意义(P>0.05).结论 硬膜外阻滞复合全麻为OPCAB围术期心肌提供良好保护作用.
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