Department of Anesthesiology and Critical Care, Fundación Alcorcón University Hospital, Alcorcón, Spain -
Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy.
Minerva Anestesiol. 2017 Jul;83(7):695-704. doi: 10.23736/S0375-9393.16.11582-2. Epub 2017 Jan 17.
Thoracic epidural anesthesia (TEA) is widely used for major surgery, but studies assessing its impact on left ventricular (LV) systolic and diastolic function are limited, and such studies have assessed patients already under general anesthesia and/or receiving volume expansion between examinations.
Observational study at a secondary university hospital including consecutive awake patients undergoing major abdominal surgery without significant pre-existing cardiac disease. Patients received a pre-emptive intravenous volume loading before epidural catheter placement with puncture between T6-T7 and T8-T9. Hemodynamic and trans-thoracic echocardiography (TTE) parameters were assessed before and after establishing TEA with a 10 mL bolus of 2% lidocaine. Changes in heart rate (HR), mean arterial pressure (MAP), stroke volume (SV), cardiac output (CO), LV systolic function (as evaluated by fractional shortening [FS]; ejection fraction [EF]; Simpson; S prime [S`]), and LV diastolic function were recorded.
Twenty-four awake patients were included. After TEA, HR, MAP, SV and CO significantly decreased (15.0%, 29.3%, 6.8% and 22%, respectively; all P<0.01); LV systolic function was also reduced by TEA (FS by 28%, EF-Simpson by 26%, S' by 15.3%, all P<0.001). TEA non-significantly reduced the incidence of diastolic dysfunction, from 65% (N.=15/23) to 43% (N.=10/23) patients (P=0.13) in the 23 complete diastolic function evaluations.
The net effect of TEA in awake patients is a reduction of HR and LV systolic function, which results in a reduction of the CO and the MAP. The effect of TEA on LV diastolic function remains to be addressed by larger studies.
胸椎硬膜外麻醉（TEA）广泛应用于大型手术，但评估其对左心室（LV）收缩和舒张功能影响的研究有限，而且这些研究评估的是已经接受全身麻醉和/或在检查之间接受容量扩张的患者。
这是一项在二级大学医院进行的观察性研究，纳入了 24 例无明显先前心脏疾病的清醒患者，这些患者接受择期行大型腹部手术。在 T6-T7 和 T8-T9 之间进行硬膜外导管放置前，给予患者预防性静脉容量负荷，随后给予 10ml 2%利多卡因冲击。在建立 TEA 后，用 10ml 2%利多卡因进行 10ml 冲击，评估患者的血流动力学和经胸超声心动图（TTE）参数。记录心率（HR）、平均动脉压（MAP）、每搏量（SV）、心输出量（CO）、LV 收缩功能（通过缩短分数[FS]；射血分数[EF]；辛普森；S 撇[S`]评估）和 LV 舒张功能的变化。
共纳入 24 例清醒患者。TEA 后，HR、MAP、SV 和 CO 明显下降（分别下降 15.0%、29.3%、6.8%和 22%；所有 P<0.01）；TEA 还降低了 LV 收缩功能（FS 下降 28%，EF-Simpson 下降 26%，S`下降 15.3%，均 P<0.001）。TEA 非显著降低舒张功能障碍的发生率，从 23 例完整舒张功能评估中 65%（N.=15/23）的患者降至 43%（N.=10/23）（P=0.13）。
TEA 在清醒患者中的净效应是 HR 和 LV 收缩功能的降低，导致 CO 和 MAP 的降低。TEA 对 LV 舒张功能的影响仍需更大规模的研究来确定。
