Effects Of High Thoracic Epidural Anesthesia On Hemodynamic And Heart Function Of Patients Undergoing Cardiac Valve Replacement By Cardiopulmonary Bypass

Objectives:1.To observe the differences of hemodynamic and heart function between using HTEA plus general anesthesia and general anesthesia alone in patients undergoing heart valve replacement by CPB.2.To discuss the effects and reasons of heart protection of HTEA, offer more methods for the anesthesia of cardiac surgery.Methods:20 patients diagnosed rheumatic heart disease were randomly assigned to 2 groups:general anesthesia group(group GA,n=10),and epidural anesthesia plus general anesthesia group(group GEA,n=10). Group GEA were punctura ed in the T3～4 the night before operation. Swan-Ganz was inserted with local anesthesia.After induction of local anesthesia and the sagment appearance from T1～T6,the two groups were induced with midazolam,fentanyl,propofol and vecuronium,use fentanyl and propofol to maintain the anesthesia during operation.The patients of two groups were treated with PCIA or PCEA after operation.Record the date of HR,MAP at the moment otT0(into operation room),T1(after general anesthesia induced),T2(separate sternum),T3(CPB 30min), T4(30min afer CPB),T5(2h after CPB),T6(4h after CPB),T7(24h after CPB).Record the date of CVP,MPAP,PCWP,CO,CI,SVI,SVR,PVR at T0,T1,T4,T5,T6,T7.Collect the venous blood at T0,T1,T3,T5,T6,T7 for corticosteroid analysis;at T0,T5,T6,T7 for cTn-I analysis.Record the dosage of sodium nitroprusside and dopamine and the new ventricular arrhythmia during the perioperative time.Record the time of exdubation and evaluate the effects of analgesia by VAS.Results:1.The HR of group GEA were significantly lower than group GA at T1,T2,T4,T5,T6,T7(p<0.05);MAP of group GEA were significantly lower than group GA at T1,T2,T3,T5,T6,T7(p<0.05),the MPAP and PCWP of group GEA were significantly lower than group GA at T6,T7(p<0.05);the CO and CI of group GEA were significantly higher than group GA at T6,the SVI of group GEA were significantly higher than group GA at T5,T6,T7.2.There's no significantly differences of Cor and cTn-I levels between two groups at T0(p>0.05);the Cor levels of group GEA were significantly lower than group GA at T3,T5,T6,T7(p<0.01);the cTn-I levels of group GEA were significantly lower than group GA at T6,T7.3.The dosagy of sodium nitroprusside of group GEA were significantly lower than group GA(p<0.05);and we recorded new ventricular arrhythmia in 3 patients of group GA during the perioperative time,but didn't find it in group GEA;the VAS for the effect of analgesia in group GEA were significantly lower than group GA(p<0.05).Conclusions: High thoracic epidural anesthesia and analgesia improve the hemodynamics and heart function of patients undergoing heart valve replacement by decrease the stress response.At the same time,the extubation time can be shortend by HTEA plus general anesthesia.These potential effections may contribute to the recovery and the outcome of patients in cardic surgery.