Boogaerts J, Lafont N
Département d'Anesthésie, Hôpitaux Civils du CPAS, Charleroi, Belgique.
Cah Anesthesiol. 1995;43(6):541-5.
The effect of epidural/spinal anaesthesia on cardiovascular function results from blockade of the sympathetic nervous system and secondly from plasma absorption of local anaesthetic agents. Patients suffering from preexisting heart diseases may have different responses to epidural or spinal anaesthesia. In patients with myocardial ischemia, the decrease in myocardial work and the reduction in heart rate induced by cervical or thoracic epidural anaesthesia improve the myocardial oxygen balance. Changes in the inotropic state induced by thoracic epidural anaesthesia may worsen the haemodynamic condition of patients with heart failure. When the spread of the epidural blockade is limited to the lower segments (< T12), changes are limited. In high risk patients, the haemodynamic advantages of a combined technique (general plus epidural anaesthesia) and the protective effect on the occurrence of myocardial ischemia and related complications are a matter of interest. Part of the beneficial effect of epidural anaesthesia could be related to postoperative analgesia and its effects on stress response and haemostasis.
硬膜外/脊髓麻醉对心血管功能的影响，一是源于交感神经系统的阻滞，二是由于局部麻醉药的血浆吸收。患有原有心脏病的患者对硬膜外或脊髓麻醉可能有不同反应。在心肌缺血患者中，颈段或胸段硬膜外麻醉引起的心肌做功减少和心率降低可改善心肌氧平衡。胸段硬膜外麻醉引起的心肌收缩状态改变可能会使心力衰竭患者的血流动力学状况恶化。当硬膜外阻滞的范围局限于下段（<T12）时，变化有限。在高危患者中，联合技术（全身加硬膜外麻醉）的血流动力学优势以及对心肌缺血及相关并发症发生的保护作用是一个值得关注的问题。硬膜外麻醉的部分有益作用可能与术后镇痛及其对应激反应和止血的影响有关。
