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Objective: 1. Comparative observation upper thoracic epidural anesthesia and general anesthesia OK bypass valve surgery patients perioperative hemodynamics and cardiac function. (2) explore the upper thoracic epidural anesthesia cardioprotective effects, its causes and potential clinical benefits for clinical cardiovascular anesthesia anesthesia to provide more options. Methods: 20 cases of rheumatic heart disease, are intended in cardiopulmonary bypass undergoing double valve replacement surgery, divided into general anesthesia group (GA group, n = 10) and upper thoracic epidural anesthesia group (GEA group , n = 10). GEA group of patients the night before surgery in T3-4 interspace epidural catheterization reserved. The day of surgery under local anesthesia after the burglary left radial artery catheterization and through the right internal jugular vein Swan-Ganz catheter placement. In GEA Group I first dose of epidural ropivacaine valid block plane of T1-T6 and hemodynamic stability, the two groups are midazolam, propofol, fentanyl, Victoria Library bromide general anesthesia was induced with fentanyl and propofol to maintain anesthesia. GA group underwent postoperative patient-controlled epidural analgesia, GEA group underwent patient-controlled analgesia. Record two groups of patients before anesthesia (T0), after intubation (T1), when sternotomy (T2), bypass 30 minutes (T3), down 30 minutes (T4), down 2 hours (T5), down 4 hours (T6) and stop 24 hours (T7), HR and MAP, and Swan-Ganz catheter through monitoring T0, T1, T4, T5, T6, T7 of CVP, MPAP, PCWP and CO changes, and calculate the corresponding CI, SVI, SVR and PVR values. Were measured T0, T1, T3, T5, T6, T7 plasma cortisol concentrations and T0, T5, T6, T7 cTn-I concentration in plasma. Record two groups of patients perioperative vasoactive drugs (nitroprusside and dopamine) and the amount of newly occurring within 24 hours after ventricular arrhythmias. The two groups were recorded 24 hours after extubation time and analgesic situation VAS score. Results: 1. Groups at T0, all hemodynamic parameters were not statistically different (p> 0.05). GEA Group HR after the start of anesthesia were significantly lower than the GA group (T4, T5, T7, p <0.05; T1, T2, T6, p <0.01), MAP at T1, T2, T3, T5, T6, T7 were significantly lower than the GA group (p <0.05). GEA group compared with the GA group, MPAP at T5, T6, T7 significant difference (p <0.05), GEA group was significantly higher than the GA group. GEA Group PCWP in T6, T7 significantly higher than the GA group (p <0.05). GEA Group CO and CI in T6 higher than the GA group (p <0.05), SVI at T5, T6, T7 significantly higher than the GEA group (p <0.05). Two groups of patients before surgery showed no significant difference in plasma cortisol (T0, T1, p> 0.05), and both began to emerge from the T3 was significantly higher (p <0.01); GEA Group at T3, T5, T6 , T7 were significantly lower than the GEA group (p <0.01). T0 two groups of patients, plasma concentrations of troponin Ⅰ was no significant difference (p> 0.05), and T6, T7 is higher than T0 (p <0.05); GEA group T6, T7 were significantly lower than GA group (p <0.05). 3 groups of patients perioperative use of sodium nitroprusside GEA group was significantly less than the total amount of GA group (p <0.05), while the total amount of dopamine was no significant difference between the two groups (p> 0.05). Within 24 hours after surgery GA group observed three cases occurred in emerging reversible ventricular arrhythmias, and in the GEA group did not observe the occurrence of ventricular arrhythmias. GEA Group extubation time was significantly earlier than the GA group (p <0.05), two groups of patients after 24 hours of VAS pain score was significantly lower than the GEA group GA group (p <0.05). Conclusions: The upper thoracic epidural anesthesia and analgesia during and after surgery by reducing the stress response can improve cardiopulmonary bypass valve surgery patients perioperative hemodynamics and cardiac function of the heart has a protective effect reduce the incidence of cardiovascular complications after. Upper thoracic epidural anesthesia also reduces postoperative extubation time and enhances postoperative analgesia. These potential beneficial effects on the recovery of patients after cardiac surgery can have a positive impact, and may ultimately affect the patient's postoperative outcome.
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