七氟醚对老年冠心病患者非心脏手术血流动力学及心肌缺血事件的影响  

The effect of sevoflurane to myocardial ischemia and intraoperative hemodynamics of elderly patients with coronary heart disease undergoing non-cardiac surgery

作　　者：许力[1] 于春华[1] 姜晶梅[2] 郑宏[3] 裴凌[4] 姚尚龙[5] 孙莉[6] 黄宇光[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院麻醉科,北京100730 [2]中国医学科学院基础医学研究所统计学与流行病学教研室,北京100730 [3]新疆医科大学第一附属医院麻醉科,新疆乌鲁木齐830054 [4]中国医科大学第一附属医院麻醉科,辽宁沈阳110001 [5]华中科技大学同济医学院附属协和医院麻醉科,湖北武汉430022 [6]中国医学科学院肿瘤医院麻醉科,北京100021

出　　处：《基础医学与临床》2013年第5期567-571,共5页Basic and Clinical Medicine

基　　金：公益性卫生行业科研专项项目(200802030);中央保健专项基金(B2009B076)

摘　　要：目的探讨七氟醚对老年冠心病患者非心脏手术心肌保护作用。方法选取4家医院择期行非心脏手术的老年冠心病患者165例,随机分两组:七氟醚持续吸入维持全身麻醉(S组,)和丙泊酚持续静脉输注维持全身麻醉(P组)。记录术中不同时点血压、心率,检测术前、术后即刻、术后第1天、第2天12导联心电图ST段和T波改变。术后随访30 d,记录术后不稳定心绞痛、心梗、心衰及心源性死亡发生情况。结果心电图提示的心肌缺血发生率:S组患者在术后各时点均低于P组,其中术后第1天(16.9%vs 30.5%)和第2天(16.9%vs 30.5%)的差异显著(P<0.05)。结论七氟醚对老年冠心病患者接受非心脏手术具有一定的心肌保护作用,但并不改变患者心脏事件发生率。Objective To evaluate the myocardial protective effects of sevoflurane in elderly patients with coronary heart disease （CHD） undergoing non-cardiac surgery. Methods It was a muhicenter prospective randomized eval- uator-blinded controlled clinical study, including 165 ASA Ⅱ - Ⅲ elderly patients with CHD undergoing elective major noncardiac surgery in 4 medical centers in China. Anesthesia was maintained with sevoflurane-air-O2 or propofol. Blood pressure, HR, and 12-lead ECG were recorded at baseline, during the surgery, immediately after the surgery, and on post-operative day 1 and day 2. ECG ST-T segment abnormalities was analyzed. Patients were followed up 30 days after surgery to record cardiac adverse events （including unstable angina, myocardial infarc- tion, congestive heart failure and cardiac death）. Results The incidence of new occurring myocardial ischemia observed by 12-lead ECG for group S was significantly lower on postoperative day 1 （16. 9% vs 30. 5%, P 〈0. 05 ） and postoperative day 2 （ 12. 0% vs 31.7 %, P 〈 0. 05 ） as compared with group P. Conchmions Sevoflurane may reduce the occurrence of postoperative myocardial ischemia for elderly patients with CHD undergoing non-cardiac surgery. Though did not change the cardiac outcomes in terms of perioperative cardiac adverse events and mortality.

关 键 词：老年 冠心病 非心脏手术 七氟醚 心肌缺血 心肌保护 

分 类 号：R541.4[医药卫生—心血管疾病]