安氟醚和异氟醚对手术中急性心肌缺血的影响  

Effect of enflurane and isoflurane on acute myocardial ischemia during the course of operation

作　　者：周易[1] 甘玉芬[1] 缪冬梅[1] 

机构地区：[1]自贡市第四人民医院,四川自贡643000

出　　处：《现代医药卫生》2004年第19期1958-1959,共2页Journal of Modern Medicine & Health

摘　　要：目的 :评价安氟醚和异氟醚对手术中急性心肌缺血患者心电图和血压的影响。方法 :43例ASAⅡ～Ⅲ级手术患者 ,按治疗药不同分成3组 ,A组15例用硝酸甘油、B组14例用安氟醚 ,C组14例用异氟醚。其中硬膜外麻醉15例(占34.9%) ,麻醉药为利多卡因 ;全身麻醉28例(占65.1 %) ,麻醉诱导药安定、氟芬合剂、羟基丁酸钠、丙泊酚和琥珀胆碱。麻醉维持药芬太尼加维库溴铵间断静注 ,同时复合吸入0.1～0.5MAC(肺泡气最低有效浓度)安氟醚或异氟醚。治疗A组硝酸甘油1～5μg·kg-1·min -1、B组1.5～2.5MAC安氟醚、C组吸入与B组相同浓度的异氟醚。硬膜外麻醉先静注氟哌啶醇2.5mg和哌替啶50mg,然后吸入安氟醚或异氟醚 ;全身麻醉则直接加大该两药的吸入浓度。采用t检验 ,比较治疗前后心率(HR)、心电波S-T段、肱动脉平均压(MBAP)和心率收缩压乘积(RPP)的变化值。结果 :除MBAP外 ,A组与B组和C组比较 ,各项均有显著性差异(P<0.01) ,而在降低HR和RPP上 ,B组与C组比较又有显著性差异(P<0.01)。结论 :安氟醚和异氟醚在迅速改善术中急性心肌缺血的心电波和血压上优于硝酸甘油 ,而安氟醚在降低RPP上又优于异氟醚。Objective:To evaluat the effect of enflurane and isoflurane on electrocardiogram(ECG) and blood pressure(BP) in patients with acute myocardial ischemia during the course of operation.Methods:43 patients with ASA(Americam society of anesthesiologists in grade Ⅱ～Ⅲscheduled for operation were divided into three groups,nitroglycerin was used in group A(n=15),enflurane was used in group B(n=14),isofluranc was used in group C(n=14).Among them,the epidura anesthesia was used in 15 cases(34.88%) and general anesthesia was used in 25 cases(62.12%).The changes of heart rate(HR),electrocardiographic S-T segment(S-T),rate-pressure product(RPP) and mean brachial artery pressure(MBAP) were monitored continuously and compared before and after treatment.Results:Compared with group B and group C,group A had significant difference in all items except for MBAP(P<0.01).The differnce between group B and group C in decreasing HR and RPP was significant(P<0.01).Conclusion:Enflurane and isoflurane are superior to nitroglycerin in improving ECG and BP of intraoperative acute myocardial ischemia,but enflurane is superior to isoflurane in decreasing RPP.

关 键 词：安氟醚 异氟醚 急性心肌缺血 吸入 手术中 硝酸甘油 硬膜外麻醉 HR 对手 显著性差异 

分 类 号：R614[医药卫生—麻醉学] R971.2[医药卫生—外科学]