不同浓度七氟醚对老年冠心病患者麻醉诱导期心率变异性的影响  

Effects of sevoflurane on heart rate variability during induction of anesthesia in elderly patients with coronary artery disease

作　　者：欧晓峰[1] 郑宏[1] 徐钊[1] 华玉思[1] 

机构地区：[1]新疆医科大学第一附属医院麻醉科,新疆乌鲁木齐830011

出　　处：《新疆医科大学学报》2011年第3期279-282,共4页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区科技支疆项目(200991126)

摘　　要：目的探讨七氟醚对老年冠心病患者在全麻诱导期心率变异性（HRV）的影响。方法 40例择期行上腹部手术老年冠心病患者,美国麻醉医生协会（ASA）Ⅱ~Ⅲ级。随机分为低浓度组和高浓度组,每组20例。麻醉诱导开始时,缓慢静脉推注芬太尼3μg/kg,吸入6 L/min氧气及七氟醚,维持七氟醚的呼气末浓度在预定值（低浓度组为2.0 Vol%,高浓度组为4.0 Vol%）,当意识和睫毛反射消失后,静注维库溴胺0.1 mg/kg,行气管插管。记录麻醉前基础值及诱导后5、10、15、20 min的收缩压（SBP）、舒张压（DBP）、心率（HR）、心率变异性（HRV）,并记录各组肌僵、呛咳、低血压等副反应的发生情况。结果 2组患者的SBP、DBP在诱导后5、10 min显著下降（P〈0.05）,高浓度组下降较低浓度组明显（P〈0.05）,其后患者的血压渐趋平稳,2组心率无显著变化（P〉0.05）。在麻醉诱导中,2组低频（LF）和低频/高频（LF/HF）逐渐降低,而HF均没有明显的变化,其中高浓度组比低浓度组对HRV各参数的影响都较明显。结论老年冠心病患者用七氟醚吸入麻醉诱导主要抑制心脏交感神经活性,并呈剂量依赖性,对血流动力学影响较轻,诱导相对平稳,适合老年冠心病患者的麻醉诱导。Objective To investigate the effects of sevoflurane on heart rate variability（HRV） during induction of anesthesia in elderly patients with coronary artery disease.Methods Forty American society of anesthesiologists（ASA） Ⅱ～Ⅲ patients with coronary artery disease aged 60～80 years weighing 45～80 kg,scheduled for elective surgery were randomly divided into inhaling sevoflurane 2%（low group,20 cases） and 4%（high group,20 cases） during induction,respectively.Electrocardiogram（ECG）,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR）and heart rate variability（HRV） were monitored before and during anesthesia.After intravenously fentanyl 3 μg/kg taken for each patient in both groups,patients in low group and high group inhaled sevoflurance with 2% and 4% concentration respectively,until falling into sleep and then vecunium 0.1 mg/kg intravenous injection.The changes of hemodynamics and HRV were observed at the time points of before induction（baseline）,and 5,10,15,20 min after intubation.Side effects such as chest wall rigidity and hypotension were also recorded.Res-ults There were no statistical differences among the two groups with respect to sex,age,weight,height,type of operation,preoperation blood pressure,HR and HRV.In both groups the SBP and DBP were significantly lower than the baseline at the time points of 5 min,10 min after induction（PM0.05）.The SBP,DBP in high group were significantly lower than those in low group（P〈0.05）;the HR of both groups remained unchanged（P〉0.05）.After the induction of anesthesia,the low frequency（LF） and LF/HF was mainly decreased in a time-depended manner in both groups,while the high frequency（HF） remained unchanged,the parameters of HRV-PSA above were dropped in high group compared with those in low group.Conclusion Sevoflurane might reduce a cardiac sympathetic tone more than parasympathetic tone and would maintain hemodynamics during the induction of anesthesia in elderly coronary heart

关 键 词：七氟醚 老年 冠心病 麻醉诱导 心率变异性 

分 类 号：R614.2[医药卫生—麻醉学]