Influence of thoracic epidural anesthesia and postoperative analgesia on lung function and ST segment in electrocardiogram after thoracotomy
Lu Huiyuan
Fan Xiaolin
Li Dajiang
Liu Jiahong
Cao Qianqian
Abstract：Objective To evaluate the influence of thoracic epidural anesthesia (TEA) and postoperative analgesia on the lung function and ST segment in electrocardiogram (ECG) after thoracotomy.Methods Forty-six patients with lung cancer complicated with coronary heart disease who underwent elective thoracic lobectomy from September 2006 to May 2014 were randondy divided into general anesthesia combined with TEA group and general anesthesia group (23 cases in each group).In general anesthesia combined with TEA group,the epidural space T5-6 was selected for puncture and 0.125％ bupivacaine + 2 μg/ml fentanyl + 0.9％ sodium chloride (totally 150 ml) were used in patient-controlled epidural analgesia (PCEA);in general anesthesia group,1 μg/ml sufentanil +0.9％ sodium chloride (totally 150 ml) were used in patient controlled intravenous analgesia (PCIA).The lung function [forced vital capacity (FVC),percentage of FEV1 and predict value (FEV1 ％),ratio of FEV1 and FVC in percentage,maximal mid-expiratory flow curve] and oxygen saturation of arterial blood (SaO2) 2 d before operation,6,24,48 and 72 h after operation,the changes of ST segment in ECG 2 d before operation,30 min after epidural anesthesia,6,24,48 and 72 h after operation were compared between groups;the visual analogue scale (VAS) score at rest and cough,the Ramsay sedation score and patient satisfaction score (PSS) were assessed;the adverse reactions.Results Two days before operation,the lung function,ST segment and SaO2 two days before operation were not significantly different between groups (P ＞ 0.05).The FVC,FEV1 6,24,48,72 h after operation,the FEV1 ％ and SaO2 24 and 48 h after operation in general anesthesia combined with TEA group were significantly higher than those in general anesthesia group[FVC:(1.8 ±0.7) L vs (1.4 0.6) L,(2.0 ±0.8) L vs (1.4 ±0.6) L,(2.1 ±0.8) Lvs (1.5±0.6) L,(2.2±0.8) Lvs (1.8±0.7) L,FEV1:(1.4±0.6) L/svs (1.1 ±0.5) L/s,(1.6±0.6) L/s vs (1.2±0.6) L/s,(1.8±0.7) L/s vs (1.3 ±0.6) L/s,(1.8 ±0.7) L/s vs (1.4±0.6) L/s,FEV1％:(58 ±9)％ vs (52 ±8)％,(61 ±9)％ vs (55 ±9)％,SaO2:(95.0± 1.9)％ vs (93.4±2.0)％,(96.0 ± 1.7) ％ vs (94.7 ± 1.6) ％] (all P ＜ 0.05).The change of ST segment 30 min after epidural anesthesia,6,24,48 and 72 h after operation in general anesthesia combined with TEA group were significantly better than those in general anesthesia group [(-0.047 ± 0.013) mV vs (-0.058 ± 0.014) mV,(-0.047 ± 0.013) mV vs (-0.058±0.013)mV,(-0.047±0.012) mV vs (-0.057±0.012) mV,(-0.046±0.012) mV vs (-0.056 ±0.011) mV] (all P＜0.05).The VAS scores at rest 6 h after operation,the VAS scores at cough 6,24 and 48 h in general anesthesia combined with TEA group were significantly lower than those in general anesthesia group (all P ＜ 0.05).The PSS scores 6,24,48 h after operation in general anesthesia combined with TEA group was significantly higher than those in general anesthesia group (P ＜ 0.05),and was not significantly different 72 h after operation between groups (P ＞ 0.05).Conclusion TEA and postoperative PCEA can effectively reduce the airway resistance,improve the lung function and myocardial blood supply,reduce the complications,and has better analgesia and higher PSS compared with PCIA in patients with lung cancer complicated with coronary heart disease undergoing thoracic lobectomy
Keywords：Thoracic lobectomyThoracic epidural anesthesiaPatient-controlled analgesiaPulmonary functionElectrocardiogram ST segment
Publication Date：2016-01-01
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：5( 353-357 )