不同浓度地氟醚对妇科手术患者心电图QTc、QTd、QTcd、Tp-e和Tp-e与QT比值的影响  

Effects of Different Concentrations of Desflurane on Electrocardiographic QTc,QTd,QTcd,Tp-e and Tp-e/QT in Patients with Gynecologic Surgery

作　　者：刘艳秋[1] 彭寒梅 王厚钧 夏阳 黄岁岁 陈惠[1] LIU Yanqiu;PENG Hanmei;WANG Houjun;XIA Yang;HUANG Suisui;CHENG Hui(Department of Anesthesiology,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学附院麻醉科,贵州贵阳550004

出　　处：《贵州医科大学学报》2020年第2期214-218,共5页Journal of Guizhou Medical University

基　　金：贵州省科技厅联合基金资助项目[黔科合LH字(2015)7424]。

摘　　要：目的:观察不同浓度地氟醚对心率校正QT间期(QTc)、QT离散度(QTd)、心率校正QT离散度(QTcd)、Tp-e间期(Tp-e)及Tp-e与QT(Tp-e/QT)比值的影响。方法:择期行妇科女性手术患者60例、ASA分级Ⅰ或Ⅱ级,采用随机数字表法均分为D1组、D2组及D3组,统一麻醉方案诱导后气管内插管,行机械通气,使D1组、D2组和D3组地氟醚浓度维持在0.6、1.3和2.0 MAC;于诱导前(T1)、地氟醚达设定浓度后10 min(T2)、15 min(T3)、20 min(T4)时采集12导联心电图,测量计算QTc、QTd、QTcd、Tp-e及Tp-/QT比值,同时记录平均动脉压(MAP)和心率(HR)。结果:与T 1比较,T 2-4时D1~D3组MAP下降,D1~D2组HR减慢,D3组HR增快,差异有统计学意义(P<0.05);与D1和D2组比较,D3组T2-4时HR增快,差异有统计学意义(P<0.05);与T1比较,T2-4时D1~D3组QTc延长,D1~D2组Tp-e/QT比值减小,差异有统计学意义(P<0.05);QTd、QTcd及Tp-e各组不同时点间比较,差异无统计学意义(P>0.05)。结论:低于2.0 MAC浓度地氟醚吸入维持麻醉不会增大患者心肌复极异质性,心律失常发生风险低。Objective:To observe the effects of different concentrations of desflurane on QTc interphase(QTc)QT dispersion(QTd),heart rate corrected QT dispersion(QTcd),Tp-e interval(Tp-e)and Tp-e/QT radio(Tp-e/QT).Methods:Sixty patients with gynecologic surgeries,through ASAⅠ~Ⅱ,scheduled for elective surgery were randomly divided into Group D1,Group D2 and Group D3 with 20 in each group.After induction of unified anaesthesia program,the patients received tracheal intubation and mechanical ventilation.With the desflurane evaporator opened,the concentrations of desflurane in D1,D2,and D3 maintained at 0.6 MAC,1.3 MAC,and 2.0 MAC respectively.12-lead ECG was collected before induction(T1)and 10(T2),15(T3),and 20 minutes(T4)after desflurane reached the set concentration.QTc,QTd,QTcd,Tp-e,and Tp-e/QT were measured and calculated.Meanwhile,mean arterial pressure(MAP)and heart rate(HR)were recorded.Results:Hemodynamic index:Compared with T 1,MAP decreased in Groups D1~D3,HR slowed down in Groups D1~D2,HR increased in Group D3 at T2-4(P<0.05).Compared with Group D1 and D2,HR increased in Group D3 at T2-4(P<0.05).Electrophysiological index:Compared with T 1,the QTc interval of Groups D1~D3 prolonged,and Tp-e/QT ratio of Groups D1~D2 decreased at T 2-4(P<0.05).There was no significant difference in QTd,QTcd,Tp-e interval in Groups D1~D3 at different time points(P>0.05).Conclusions:Inhalation maintenance anesthesia with desflurane concentration below 2.0 MAC can not increase cardiac repolarization heterogeneity in patients with gynecologic surgeries,and the risk of arrhythmia was low.

关 键 词：麻醉药 心电描记术 地氟醚 心律失常 妇科手术 

分 类 号：R614[医药卫生—麻醉学]