麻醉性镇痛药对老年患者麻醉期间心肌缺血和心律失常的影响  

Effect of Narcotic Analgeiscs on Perioperative Myocardial Ischemia and Arrhythmia in Elderly Patients with Noncardiac Surgery

作　　者：张冬梅[1] 曹池[1] 王海滨[1] 廖红[1] 桑晓银[2] 邱玉雪[1] 

机构地区：[1]宁夏医科大学总医院麻醉科,银川750004 [2]宁夏医科大学总医院心电图室,银川750004

出　　处：《宁夏医科大学学报》2012年第10期1009-1011,1015,共4页Journal of Ningxia Medical University

基　　金：宁夏医科大学校级项目(XZ200806)

摘　　要：目的观察不同阿片类药物在全凭静脉麻醉中对老年非心脏手术患者围术期心肌缺血和心律失常的影响。方法 60例年龄60岁以上全麻手术病人随机分为芬太尼(FR)组或舒芬太尼0.3μg.kg-1(SR1)组和0.6μg.kg-1(SR2)组,每组20例,ASA I～II记录麻醉诱导前、气管插管前、插管后3min、切皮后即刻、切皮后1h、术毕平均动脉压(MAP)、心率(HR),动态心电图记录围术期心律失常及心肌缺血发生情况,分析心率变异性(HRV)的变化。并于诱导前、切皮1h、术毕及术后6h检测血浆肌钙蛋白T(cTnT)。结果 SR1、SR2组插管3min后的HR、MAP明显低于FR组(P<0.05);与诱导前比较,插管3min时FR组HR、MAP明显高于诱导前(P<0.05),SR2组则低于诱导前水平(P<0.05)。cTnT术后6h仅SR2组明显低于FR组(P<0.05);与诱导前比较三组cTnT在术后6h均有所升高(P<0.05)。三组围术期心律失常以术后多见,组间比较差异无统计学意义(P>0.05)。心肌缺血发生率SR1组和SR2组略低于FR组,但差异无统计学意义(P>0.05)。SR2组PNN50及RMSSD明显高于FR组(P<0.05)。结论舒芬太尼作为强效镇痛药比芬太尼更有益于维持血流动力学的稳定,对减轻老年非心脏手术围术期心肌缺血和心律失常有一定作用。Objective The effects of different opioids in total intravenous anesthesia on elderly patients with non -cardiac surgery perioperative myocardial ischemia and arrhythmia Methods sixty patients （ 〉 60 years old） undergoing noncardiac surgery were randomly assigned to fentanyl（group FR） or sufentanil （group SR1 ）and （Group SR2） with 20cases in each, ASA I -II. The mean arterial pressure （MAP） and heart rate （HR） were recorded before induction of anesthesia, tracheal intubation, after intubation 3min, immediately after skin incision, after incision 1 h and the end of operation. The Hoher recorded perioperative incidence of arrhythmia and myocardial ischemia. The changes of HRV was analysised. Plasma troponin T（cTnT） in pre - induction, skin incision 1 h, the end of operation and 6h after surgery were detected. Results The MAP and HR of group SR1 and group SR2 in 3min after intubation was significantly lower than those of the group FR （P〈 0.05 ）. Compared with the before induction, the MAP and HR of the group FR in 3min after intubation was significantly higher （ P 〈 0.05 ）, group SR2 was significantly lower （ P 〈 0.05 ）. The cTnT of group SR2 in 6h after surgery was significantly lower than that of the group FR （P 〈 0.05 ）. Compared with the before the induction, The cTnTs of three groups were elevated after 6h after surgery （P 〈 0.05 ）. The arrhythmias in patients were more common after surgey and showed no significant difference （P 〉 0.05 ） in each group. The incidence of myocardial ischemia of the group SR1 and group SR2 was lower than that of group FR, but no statistically significant difference （ P 〉 0.05 ）. PNN50 and RMSSD of the Group SR2 were significantly higher than those of the group FR （P 〈 0. 05 ）. Conclusion Sufentanil as a potent analgesic compared with fentanyl is more beneficial to maintain hemodynamic stability, and if is useful to reduce perioperative myocardial ischemia and arrhythmia in elderly non- cardiac surgery.

关 键 词：舒芬太尼 心肌缺血 心律失常 心率变异性 老年病人 

分 类 号：R614.2[医药卫生—麻醉学]