Blomberg S, Emanuelsson H, Ricksten S E
Department of Anesthesia and Intensive Care, University of Gothenburg, Sahlgren's Hospital, Sweden.
Anesth Analg. 1989 Nov;69(5):558-62.
The effects of high thoracic epidural anesthesia (TEA) on central hemodynamics as measured by pulmonary arterial catheterization were studied in nine patients with severe coronary artery disease and unstable angina pectoris. The patients were also treated with a combination of beta-blockers, calcium antagonists, and nitrates, as well as salicylates, low-dose heparin, and nitroglycerin infusion for greater than 24 hr. Management of pain with high TEA was started with the bolus epidural injection of 4.3 +/- 0.2 mL bupivacaine (5 mg/mL), which induced a sympathetic blockade from Th. During ischemic chest pain, pulmonary artery and pulmonary capillary wedge pressures were significantly increased. TEA, while relieving the chest pain, significantly decreased systolic arterial blood pressure, heart rate, and pulmonary artery and pulmonary capillary wedge pressures, without any significant changes in coronary perfusion pressure, cardiac output, stroke volume, and systemic or pulmonary vascular resistances. In some patients, ST-segment depression was less pronounced during TEA. Thus, during ischemic chest pain, TEA has beneficial effects on the major determinants of myocardial oxygen consumption, without jeopardizing coronary perfusion pressure. TEA may therefore favorably alter the oxygen supply/demand ratio within ischemic myocardial areas.
对9例严重冠状动脉疾病和不稳定型心绞痛患者进行了研究，以肺动脉导管插入术测量高胸段硬膜外麻醉（TEA）对中心血流动力学的影响。这些患者还接受了β受体阻滞剂、钙拮抗剂和硝酸盐的联合治疗，以及水杨酸盐、低剂量肝素和硝酸甘油输注超过24小时。采用高胸段硬膜外麻醉进行疼痛管理时，首先经硬膜外推注4.3±0.2 mL布比卡因（5 mg/mL），可诱导胸段交感神经阻滞。在缺血性胸痛期间，肺动脉和肺毛细血管楔压显著升高。TEA在缓解胸痛的同时，显著降低收缩动脉血压、心率、肺动脉和肺毛细血管楔压，而冠状动脉灌注压、心输出量、每搏量以及体循环或肺血管阻力无明显变化。在一些患者中，TEA期间ST段压低不那么明显。因此，在缺血性胸痛期间，TEA对心肌氧消耗的主要决定因素具有有益作用，而不会危及冠状动脉灌注压。因此，TEA可能会有利地改变缺血心肌区域内的氧供需比。
