中国现代医学杂志2018，Vol.28Issue(7)：88-93,6.DOI:10.3969/j.issn.1005-8982.2018.07.018
七氟烷对老年冠状动脉粥样硬化性心脏病患者围术期血流动力学调控和心肌的影响研究
Influence of Sevoflurane on perioperative hemodynamics and myocardium in elderly patients with coronary heart disease
王亦瑶 1李毓 1韩学昌 1邢群智 1周民涛 1董旭 1常俊晓1
作者信息
- 1. 河南科技大学第一附属医院 麻醉科,河南 洛阳 471003
- 折叠
摘要
Abstract
Objective To investigate the influence of Sevoflurane on perioperative hemodynamics and myocardium in elderly patients with coronary heart disease undergoing noncardiac surgery. Methods One hundred elderly patients with coronary heart disease who received elective laparoscopic surgery were randomly assigned to Sevoflurane group (group S) and Propofol group (group P), each group had 50 patients. Bispectral index (BIS) was used to monitor the depth of sedation in the intraoperative period. Heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), left cardiac work (LCW) were recorded before induction of anesthesia (Ta0), before intubation (Ta1), 1 min after intubation (Ta2), at the start of surgery (Ta3), before extubation (Ta4) and 5 min after extubation (Ta5). Central venous blood was drawn 5 min before induction of anesthesia (Tb0), at the end of surgery (Tb1), 12 h (Tb2), 24 h (Tb3) and 48 h (Tb4) after suegery for measurements of troponin I (cTnI) and creatine kinase isoenzyme (CK-MB). Intraoperative dosage of Remifentanil and postoperative visual simulation score (VAS) were compared between the two groups. Results HR, MAP, SVR and LCW at Ta1 and Ta3were lower than those at Ta0in both groups (P < 0.05). In the group P, CO at Ta3and CI at Ta2and Ta3were lower than those at Ta0(P < 0.05). HR at Ta1and MAP at Ta2in the group S were lower than those in the group P (P < 0.05). CI at Ta2and Ta3in the group S were higher than those in the group P (P < 0.05). cTnI and CK-MB levels in postoperative period were significantly increased compared with Tb0values in both groups. However, the level of CK-MB reached the peak at Tb3, descended at Tb4, whereas the level at Tb4was still higher than that at Tb0(P < 0.05). Compared with the group P, cTnI and CK-MB at Tb2, Tb3and Tb4were significantly lower in the group S (P < 0.05). The intraoperative dosage of Remifentanil in the group S was obviously lower than that in the group P (P < 0.05). But the postoperative VAS in the two groups had no significant difference (P > 0.05). Conclusions Sevoflurane anesthesia has slight effect on the hemodynamic factors, can reduce surgical stress and perioperative myocardial injury, has better myocardial protection in elderly patients with coronary heart disease undergoing noncardiac surgery. We suggest the widespread usage of it in clinic.关键词
老年冠心病患者/七氟烷/丙泊酚/血流动力学/肌钙蛋白I/肌酸激酶同工酶Key words
elderly patients with coronary heart disease/Sevoflurane/Propofol/hemodynamics/troponin I/creatine kinase isoenzyme分类
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王亦瑶,李毓,韩学昌,邢群智,周民涛,董旭,常俊晓..七氟烷对老年冠状动脉粥样硬化性心脏病患者围术期血流动力学调控和心肌的影响研究[J].中国现代医学杂志,2018,28(7):88-93,6.
