吸入低浓度七氟烷对合并冠心病的非心脏手术患者的围术期心肌保护效应分析  

Analysis on effect of inhaling low concentration of sevoflurane in protection of perioperative myocardium in non-cardiac surgery patients with coronary heart disease

作　　者：吴绪才[1] 高子军 肖莉[1] 董补怀[1] WU Xucai;GAO Zijun;XIAO Li;DONG Buhuai(Department of Anesthesiology,Red Cross Hospital Affiliated to Xi′an Jiaotong University,Xi′an,Shaanxi,710054)

机构地区：[1]西安交通大学附属红会医院麻醉科,陕西西安710054

出　　处：《实用临床医药杂志》2020年第23期70-72,91,共4页Journal of Clinical Medicine in Practice

基　　金：陕西省卫生和计划委员会课题(S2016TFSF0376)。

摘　　要：目的观察吸入低浓度(1.0%~2.5%)七氟烷并保持脑电双频指数(BIS)为45~55对合并冠心病的非心脏手术患者围术期的心肌保护效应。方法选取100例合并冠心病的非心脏手术患者作为研究对象,采用随机投掷法分为A组、B组、C组,3组麻醉诱导方案相同。A组未吸入七氟烷,保持BIS为35~44;B组吸入2.6%~4.0%七氟烷,保持BIS为35~44;C组持续吸入1.0%~2.5%七氟烷,并保持BIS为45~55。结果3组患者手术时间、术中出血量、术中补液量比较,差异无统计学意义(P>0.05);C组低血压、心动过缓及心肌缺血的发生率低于B组,差异有统计学意义(P<0.05);麻醉诱导前、插管时,3组患者心肌肌钙蛋白T(cTnT)、超敏C反应蛋白(hs-CRP)水平比较,差异无统计学意义(P>0.05);拔管即刻,C组cTnT、hs-CRP水平低于A组、B组,差异有统计学意义(P<0.05)。结论吸入1.0%~2.5%七氟烷并保持BIS为45~55,可改善合并冠心病的非心脏手术患者的围术期心肌保护效果,并降低心血管不良事件的发生率。Objective To analyze the effect of inhaling sevoflurane at concentration of ranging from 1.0%to 2.5%and maintaining Bispectral Index(BIS)of 45 to 55 on perioperative myocardial protection in coronary heart disease patients with non-cardiac surgery.Methods A total of 100 coronary heart disease patients undergoing thoracoabdominal surgery were selected and divided into groups A,B,and C according to random throwing method.The three groups had the same induction protocol,and group A was not given sevoflurane inhalation,with BIS of 35 to 44,group B was given sevoflurane inhalation at concentration of 2.6%to 4.0%,with BIS of 35 to 44,group C was given sevoflurane inhalation at concentration of 1.0%to 2.5%,BIS maintained 45 to 55.Results There were no significant differences in the operation time,intraoperative blood loss,and intraoperative fluid replacement volume among the three groups(P>0.05);the incidence rates of hypotension,bradycardia,and myocardial ischemia in the group C were significantly lower than those in the group B(P<0.05);there were no significant differences in cardiac troponin T(cTnT),hypersensitive C-reactive protein(hs-CRP)levels before intubation and at intubation in the three groups(P>0.05);cTnT and hs-CRP levels in the group C were significantly lower than groups A and B at extubation(P<0.05).Conclusion Sevoflurane inhalation at concentration of 1.0%to 2.5%and maintaining BIS of 45 to 55 can improve the efficacy in protection of perioperative myocardium in non-cardiac surgery patients with coronary heart disease,and can reduce the incidence of cardiovascular adverse events.

关 键 词：七氟烷 非心脏手术 冠心病 心肌保护 麻醉诱导 拔管即刻 脑电双频指数 

分 类 号：R614[医药卫生—麻醉学] R541.4[医药卫生—外科学]