The Dependablity Clinical Reasearch Of Intraoperation Stress Reaction And Myocardiac Ischemia

Objective: This study sought to deterimine whether stress reaction is one of the important factors of intraoperation myocardiac ischemia through investigating the relationship of intraoperation stress reaction and myocardiac ischemia in patients with intermediate risk factors of cardiovascular disease undergoing noncardiac surgery. Methods: 60 patients who have intermediate risk for perioperation cardiovascular events according to the ACC/AHA Guideline for Perioperative Cardiovascular Evaluation for noncardiac surgery were studied as our research objects. we phlebotomized blood at the time when patients got in operation room(OR)and calm down(T₀), the time when patients were anaesthetized(T₁), the time when the key procession of the operation were getting done(T₂) and the time when the operation finished(T3), at the same time ,the vital sign were recorded, the samples were assayed to define the consistency of cortisol ,IL-6and blood glucose for defining the degree of stress reaction. The holter were put to each patient when he entered into the OR for mornitering the ST-segment of DCG to know whether patients have occurred myocardiac ischemia .Patients were classified into two groups,group of general anesthesia (Group I )and continuous epidural anesthesia(Group â…¡ ) ,each group was devided into group myocardiac ischemia and nonmyocardiac ischemia (Group â…  a, â…  b and â…¡a, â…¡b).We used the analysis of variance to analyze the realationship of stress reaction and the conditions of myocardiac ischemia. Results: There are 34 patients in Group I , 23 patients in Group I a and 1 ] patients in Group I b,there 26 patients in Group â…¡, 17 patients in Group â…¡a and 9 patients in Group â…¡b. Group of general anesthesia (Group I ) :The Blood Pression(BP) and Heart Rate(HR) of timeTi > T2 ^ T3 are lower than time of To in Group I a, and there is no significant change among time of T^ T2 ^ T3. The BP and HR of time Ti are higher than time of To in Group I b, and its got lower at time of T2 s T3. At time of T], the BP and HR of Group I b are higher than Group I a.The cortisol's changes have no significant difference in Group I a,the cortisol is higher at time of Ti> T2 than To> T3 in Group I b ,at time of Ti ^ T2, the cortisol of Group I b are higher than Group I a The IL-6 has the same change trend as the cortisol. The blood glucose(BG)'s changes have no significant difference in Group I a, and it got higher at time of in Tj > T2 than time of To in Group I b, there is no significant difference between Group I a and Group I b at time of To, and Group I b's BG is higher than Group I a at time of Tj ^ T2n T3. Group of continuous epidural anesthesia (Group II ) : The BP and HR's changes have no significant difference in Group II a, the BP and HR of Group II b have declined significantly at time of Ti -> T2i then rised at time of T3> compared with Group II a, Group II b's BP and HR are lower at time of Ti -. T2. The cortisol's changes have no significant difference in Group II a, the Group II b'cortisol at time of Ti > T2 is significantly lower than time of To. The IL-6 and BG have the same change trend as the BP and HR. Conclusions: In general anesthesia patients, to a certain extent, the intraoperation stress reaction and myocardiac ischemia have some dependence; the myocardiac ischemia of general anesthesia patients does easily happen on the time after trachea intubated .which is caused by the stress reaction of trachea intubated ; the myocardiac ischemia of continuous epidural anesthesia patients is mostly caused by excessively sympathetic nerve blocking and vagus reflex which cause filling defect of coronary artery .