|
Extremely high due to myocardial oxygen demand, ischemia and hypoxia is very sensitive to myocardial injury prone, especially in perioperative prone to ischemic myocardial injury. Blood cardiac troponin I (cTnI) in myocardial injury the early serum concentration of long duration, with a high degree of specificity and sensitivity of diagnosis of perioperative myocardial injury, also can be used as a marker of myocardial protection for assessment of perioperative myocardial protective effect and prognosis judgment is worth promoting serum markers. Sevoflurane and epidural anesthesia compared with propofol TIVA in inducing and maintaining smooth and quickly regained consciousness, circulatory depression, mild perioperative be able to maintain a relatively stable hemodynamics. Objective: compare seven desflurane combined with epidural anesthesia and total intravenous anesthesia for elderly upper abdominal surgery, comparing two different anesthetic methods on patients perioperative myocardial enzymes and cardiac troponin I (cTnI) affect sevoflurane may be combined with epidural anesthesia myocardial protection mechanism. Methods: elective abdominal surgery on 80 patients in the elderly, ASA Ⅰ ~ Ⅱ grade, age 61 to 83 years old. Sevoflurane and epidural anesthesia (S) were randomly divided into groups and propofol TIVA (P) group, 40 cases in each group. Heart disease, difficult intubation, central nervous system diseases, sepsis, liver and kidney function and endocrine disorders, who were not within the range of options. All patients were fasted for 12 hours, and forbidden to drink four hours. The sex ratio of the 2 groups of patients, age, weight, and anesthesia time difference no statistically significant (P> 0.05). 30 minutes of intramuscular atropine 0.5mg, patients the burglary open venous access, infusion of sodium lactate Ringer's solution and 6% hydroxyethyl starch preoperative injection. S group epidural catheter insertion after administration of the test dose induction: forces month West 0.1 ~ 0.2mg/kg, fentanyl 1 ~ 3μg/kg, etomidate 0.3mg/kg vecuronium 0.08 to 0.12 mg / kg. Maintained intraoperative inhaled 1% to 2% sevoflurane and remifentanil 0.01 ~ 0.1μg / (kg / min), intermittent given vecuronium, epidural intermittent given a local anesthetic, the end of surgery to stop inhalation anesthetics. Induced P group: force January West 0.1 ~ 0.2mg/kg, fentanyl 3μg/kg etomidate 0.3mg/kg vecuronium 0.08 to 0.12mg/kg. Intraoperative infusion of propofol 0.06 to 0.12mg / (kg / min), remifentanil 0.01 to 0.1ug / (kg / min), intermittent given vecuronium, stop at the end of surgery, propofol infusion. Intraoperative continuous monitoring of the multifunctional monitor noninvasive mean arterial pressure (MAP), heart rate (HR), electrocardiogram (ECG) and pulse oximetry saturation (SPO 2 ), in patients with spontaneous breathing completely restore sober after extubation. Before anesthesia, intubation, extubation after 5min, 6,24,48 h after blood collection check serum creatine kinase (CK), creatine kinase MB (CKMB), aspartate amino transferase (AST ), lactate dehydrogenase (LDH) and cTnI concentration. : P group CK, AST, LDH of surgery and postoperative were significantly higher than before anesthesia (P <0.05). cTnI after surgery were significantly higher than before anesthesia (P <0.01). Each index of the S group showed no change before anesthesia significant sex (P> 0.05); S group CK, AST was significantly lower than at the end of surgery and 6 h after the P group (P <0.05), LDH significantly after 6h lower than the P group (P <0.05), and cTnI in postoperative 6, 24 and 48 h were significantly lower than the P group (P <0.05). Conclusion: sevoflurane combined with epidural anesthesia for elderly patients with abdominal surgery to reduce elderly patients with perioperative myocardial damage more than propofol TIVA group.
|