Kock M, Blomberg S, Emanuelsson H, Lomsky M, Strömblad S O, Ricksten S E
Department of Anesthesia and Intensive Care, University of Gothenburg, Sahlgren's Hospital, Sweden.
Anesth Analg. 1990 Dec;71(6):625-30. doi: 10.1213/00000539-199012000-00009.
The aim of the present investigation was to study the effects of high thoracic epidural anesthesia (TEA), including the cardiac sympathetic segments, on ischemic ST-segment changes and left ventricular global and regional wall motion abnormalities. Ten patients with a two- or three-vessel coronary artery disease, all treated with the beta-adrenergic blocker metoprolol because of severe stable angina pectoris, performed two identical exercise stress tests, the first without TEA (control exercise) and the second with TEA (TEA exercise). Before each stress test, intravenous metoprolol was given to achieve maximal or near maximal beta-adrenoceptor blockade. Systolic and diastolic arterial pressures (radial artery cannula), heart rate, and rate-pressure product, as well as global and regional ejection fractions, using equilibrium radionuclide angiography in the left anterior oblique projection, were measured at rest and during maximal exercise. ST-segment analysis (V3 or V5) was performed, and the regional wall motion score was calculated at control exercise and TEA exercise. Intravenous metoprolol or intravenous metoprolol plus TEA at rest did not cause any significant changes of any of the variables. During TEA exercise, systolic arterial pressure, diastolic arterial pressure, and rate-pressure product, but not heart rate, were significantly lower compared to control exercise. The global and anterolateral ejection fractions were significantly higher (52.8% versus 46.5% and 53.2% versus 46.0%, respectively, P less than 0.05), and the regional wall motion score was significantly lower (8.8 versus 11.8, P less than 0.01) during TEA exercise than during control exercise. ST-segment depression was significantly lower during TEA exercise (-1.03 versus -1.84 mV, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
本研究的目的是探讨包括心脏交感神经节段在内的高位胸段硬膜外麻醉（TEA）对缺血性ST段改变以及左心室整体和局部壁运动异常的影响。10例患有双支或三支冠状动脉疾病的患者，均因严重稳定型心绞痛接受β-肾上腺素能阻滞剂美托洛尔治疗，进行了两次相同的运动负荷试验，第一次无TEA（对照运动），第二次有TEA（TEA运动）。在每次负荷试验前，静脉给予美托洛尔以实现最大或接近最大的β-肾上腺素能受体阻滞。在静息和最大运动时，测量收缩压和舒张压（桡动脉插管）、心率、心率-血压乘积，以及使用左前斜位平衡放射性核素血管造影术测量整体和局部射血分数。进行ST段分析（V3或V5），并计算对照运动和TEA运动时的局部壁运动评分。静息时静脉注射美托洛尔或静脉注射美托洛尔加TEA不会引起任何变量的显著变化。与对照运动相比，在TEA运动期间，收缩压、舒张压和心率-血压乘积显著降低，但心率无显著变化。TEA运动期间的整体和前外侧射血分数显著更高（分别为52.8%对46.5%和53.2%对46.0%，P<0.05），且局部壁运动评分显著更低（8.8对11.8，P<0.01）。TEA运动期间的ST段压低显著更低（-1.03对-1.84 mV，P<0.01）。（摘要截选至250字）
